Provider Demographics
NPI:1629476452
Name:HAMILTON, DERRICK (DC)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-3940
Mailing Address - Country:US
Mailing Address - Phone:618-416-1123
Mailing Address - Fax:217-803-2485
Practice Address - Street 1:140 IOWA AVE STE 7
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-3940
Practice Address - Country:US
Practice Address - Phone:618-416-1123
Practice Address - Fax:217-803-2485
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor