Provider Demographics
NPI:1780652701
Name:HAMILTON, THOMAS R (DC DACNB)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:DC DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 FAIRFAX RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-3719
Mailing Address - Country:US
Mailing Address - Phone:812-473-4070
Mailing Address - Fax:812-473-3461
Practice Address - Street 1:4012 FAIRFAX RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-3719
Practice Address - Country:US
Practice Address - Phone:812-473-4070
Practice Address - Fax:812-473-3461
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM300032075Medicare PIN
T35121Medicare UPIN
IN636810AMedicare ID - Type Unspecified