Provider Demographics
NPI:1841016953
Name:HAMILTON, JARED (DC)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:HAMILTON
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 1:41 PILGRIM DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7067
Mailing Address - Country:US
Mailing Address - Phone:904-505-9210
Mailing Address - Fax:
Practice Address - Street 1:11048 BAYMEADOWS RD UNIT 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9583
Practice Address - Country:US
Practice Address - Phone:904-363-3327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH15243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH15243OtherCHIROPRACTIC LICENSE