Provider Demographics
NPI:1265432272
Name:HAMADANCHI, HOSSEIN (DC)
Entity type:Individual
Prefix:
First Name:HOSSEIN
Middle Name:
Last Name:HAMADANCHI
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 1:2914 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2437
Mailing Address - Country:US
Mailing Address - Phone:269-983-2221
Mailing Address - Fax:269-983-2245
Practice Address - Street 1:2914 DIVISION ST
Practice Address - Street 2:
Practice Address - City:ST. JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2437
Practice Address - Country:US
Practice Address - Phone:269-983-2221
Practice Address - Fax:269-983-2245
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1563540Medicaid
MI0A15046Medicare ID - Type Unspecified