Provider Demographics
NPI:1861575052
Name:HAMILTON, ROBERT (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
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 1:1380 GALAXY WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4912
Mailing Address - Country:US
Mailing Address - Phone:925-825-8058
Mailing Address - Fax:925-825-8080
Practice Address - Street 1:1380 GALAXY WAY
Practice Address - Street 2:SUITE B
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4912
Practice Address - Country:US
Practice Address - Phone:925-825-8058
Practice Address - Fax:925-825-8080
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26552111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0266420Medicare ID - Type Unspecified
CAU79831Medicare UPIN