Provider Demographics
NPI:1689755233
Name:HAMILTON, DIRK STARR (DC)
Entity Type:Individual
Prefix:
First Name:DIRK
Middle Name:STARR
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:PO BOX 1589
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96156-1589
Mailing Address - Country:US
Mailing Address - Phone:530-541-2345
Mailing Address - Fax:
Practice Address - Street 1:3320 SANDY WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-8105
Practice Address - Country:US
Practice Address - Phone:530-541-2345
Practice Address - Fax:530-542-9500
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor