Provider Demographics
NPI:1336219674
Name:HAMRICK SPECIFIC CHIROPRACTIC
Entity Type:Organization
Organization Name:HAMRICK SPECIFIC CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:HAMRICK
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:304-598-3334
Mailing Address - Street 1:3081 UNIVERSITY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3323
Mailing Address - Country:US
Mailing Address - Phone:304-598-3334
Mailing Address - Fax:304-225-6046
Practice Address - Street 1:3081 UNIVERSITY AVE STE B
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3323
Practice Address - Country:US
Practice Address - Phone:304-598-3334
Practice Address - Fax:304-225-6046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV815111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005052Medicaid
WV9357411Medicare ID - Type Unspecified
WV3810005052Medicaid