Provider Demographics
NPI:1124453410
Name:MICAH HAMILTON CHIROPRACTIC INC.
Entity type:Organization
Organization Name:MICAH HAMILTON CHIROPRACTIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-228-9311
Mailing Address - Street 1:23792 ROCKFIELD BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2868
Mailing Address - Country:US
Mailing Address - Phone:949-470-4757
Mailing Address - Fax:949-470-4777
Practice Address - Street 1:23792 ROCKFIELD BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2868
Practice Address - Country:US
Practice Address - Phone:949-470-4757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31333111NR0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty