Provider Demographics
NPI:1841339611
Name:HAMILTON, MICHAEL WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
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 1:15545 W 87TH ST PKWY
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219
Mailing Address - Country:US
Mailing Address - Phone:913-541-1919
Mailing Address - Fax:913-894-4427
Practice Address - Street 1:15545 W 87TH ST PKWY
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219
Practice Address - Country:US
Practice Address - Phone:913-541-1919
Practice Address - Fax:913-894-4427
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-3933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS15503039OtherBLUE CROSS BLUE SHIELD KC
KSU16474Medicare UPIN
KS0001564Medicare PIN