Provider Demographics
NPI:1922160795
Name:HAMILTON, JOHN ROBERT JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:HAMILTON
Suffix:JR
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 1:1119 TUSCULUM BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4038
Mailing Address - Country:US
Mailing Address - Phone:423-638-2233
Mailing Address - Fax:423-638-9972
Practice Address - Street 1:1119 TUSCULUM BLVD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4038
Practice Address - Country:US
Practice Address - Phone:423-638-2233
Practice Address - Fax:423-638-9972
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100032089OtherPHP TENNCARE
TN3067033OtherBCBS
TN100032089OtherPHP TENNCARE
3679207Medicare ID - Type Unspecified