Provider Demographics
NPI:1619491990
Name:HAMLETT, LACEY ANN
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:ANN
Last Name:HAMLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 DODGE RD NE
Mailing Address - Street 2:STE 104
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2411
Mailing Address - Country:US
Mailing Address - Phone:319-261-0052
Mailing Address - Fax:319-261-0054
Practice Address - Street 1:1950 DODGE RD NE
Practice Address - Street 2:STE 104
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2411
Practice Address - Country:US
Practice Address - Phone:319-261-0052
Practice Address - Fax:319-261-0054
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA087448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor