Provider Demographics
NPI:1629269071
Name:HAMADY, MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:HAMADY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 N EL CAMINO REAL STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3713
Mailing Address - Country:US
Mailing Address - Phone:650-348-4118
Mailing Address - Fax:650-348-6857
Practice Address - Street 1:654 N EL CAMINO REAL STE 102
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3713
Practice Address - Country:US
Practice Address - Phone:650-348-4118
Practice Address - Fax:650-348-6857
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0226970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0226970Medicare Oscar/Certification
CADC0226970Medicare UPIN
CADC0226970Medicare PIN