Provider Demographics
NPI:1316091069
Name:HAMER, DOUGLAS ALLEN (DC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ALLEN
Last Name:HAMER
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 1:2903 COMMON STREET
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8534
Mailing Address - Country:US
Mailing Address - Phone:337-491-1141
Mailing Address - Fax:337-433-7944
Practice Address - Street 1:2903 COMMON STREET
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8534
Practice Address - Country:US
Practice Address - Phone:337-491-1141
Practice Address - Fax:337-433-7944
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA339111N00000X
TX5156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA20204OtherBLUE CROSS
59222Medicare ID - Type Unspecified
T19985Medicare UPIN