Provider Demographics
NPI:1194714782
Name:HAMMEL, SAMUEL GLEN (DC)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:GLEN
Last Name:HAMMEL
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 1:1909 CUBA AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5646
Mailing Address - Country:US
Mailing Address - Phone:575-214-2800
Mailing Address - Fax:575-214-2802
Practice Address - Street 1:1909 CUBA AVE STE 1
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5646
Practice Address - Country:US
Practice Address - Phone:575-214-2800
Practice Address - Fax:575-214-2802
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1669111N00000X
MISH005066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950A250000OtherBCBS
MI1619940Medicaid
MI1861717951OtherBCBSM GROUP
MI1861717951OtherBCBSM GROUP
MI950A250000OtherBCBS