Provider Demographics
NPI:1699910059
Name:KEVIN D. HAMILTON, DC
Entity type:Organization
Organization Name:KEVIN D. HAMILTON, DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DUNCAN
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC,CCSP,PC
Authorized Official - Phone:563-344-6060
Mailing Address - Street 1:3420 ELMORE AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2594
Mailing Address - Country:US
Mailing Address - Phone:563-344-6060
Mailing Address - Fax:563-344-6061
Practice Address - Street 1:3420 ELMORE AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2594
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:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0747485Medicaid
IAU01950Medicare UPIN
IA0747485Medicaid