Provider Demographics
NPI:1700148194
Name:HAMEL CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:HAMEL CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:HAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-942-6272
Mailing Address - Street 1:425 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:IL
Mailing Address - Zip Code:62016-1136
Mailing Address - Country:US
Mailing Address - Phone:217-942-6272
Mailing Address - Fax:
Practice Address - Street 1:425 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:IL
Practice Address - Zip Code:62016-1136
Practice Address - Country:US
Practice Address - Phone:217-942-6272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty