Provider Demographics
NPI:1386793677
Name:HAMILTON, KENNETH LORNE (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LORNE
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 1:22546 ARDMORE PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2011
Mailing Address - Country:US
Mailing Address - Phone:586-773-6762
Mailing Address - Fax:
Practice Address - Street 1:27889 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1542
Practice Address - Country:US
Practice Address - Phone:586-774-7171
Practice Address - Fax:586-774-6253
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004816111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1628250Medicaid
MI0E05015Medicare UPIN
MI1628250Medicaid