Provider Demographics
NPI:1922164102
Name:HAMMON, KENNETH WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WAYNE
Last Name:HAMMON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10311 CROSS CREEK BLVD
Mailing Address - Street 2:STE E
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2989
Mailing Address - Country:US
Mailing Address - Phone:727-791-0099
Mailing Address - Fax:727-791-2257
Practice Address - Street 1:10311 CROSS CREEK BLVD
Practice Address - Street 2:STE E
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2989
Practice Address - Country:US
Practice Address - Phone:727-791-0099
Practice Address - Fax:727-791-2257
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6564111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor