Provider Demographics
NPI:1912299355
Name:KEVIN HAMILTON DC-PC
Entity Type:Organization
Organization Name:KEVIN HAMILTON DC-PC
Other - Org Name:ELMORE CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-344-6060
Mailing Address - Street 1:3719 BRIDGE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1807
Mailing Address - Country:US
Mailing Address - Phone:563-344-6060
Mailing Address - Fax:563-344-6061
Practice Address - Street 1:3719 BRIDGE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-1807
Practice Address - Country:US
Practice Address - Phone:563-344-6060
Practice Address - Fax:563-344-6061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA05686OtherWELLMARK BLUE CROSS BLUE SHIELD
IA0747485Medicaid