Provider Demographics
NPI:1851519219
Name:HAMILTON, KRISTIN MICHELLE (LAC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:MICHELLE
Other - Last Name:MACEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4742 LIBERTY RD S
Mailing Address - Street 2:#328
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5037
Mailing Address - Country:US
Mailing Address - Phone:503-910-3140
Mailing Address - Fax:
Practice Address - Street 1:830 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4108
Practice Address - Country:US
Practice Address - Phone:503-910-3140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00980171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist