MEDICARE: JAMI A. HAMILTON, DC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	12197	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	263573	OTHER	TX	MEDICARE PTAN

General Provider Information

NPI Number	:	1568729887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMI A. HAMILTON, DC, LLC

Provider Business Mailing Address
First Line	:	100 KIOWA DR W
Second Line	:	SUITE 301
City	:	LAKE KIOWA
State	:	TX
Zip	:	76240-9584
Country	:	US
Telephone Number	:	940-668-8755
Fax Number	:	940-222-7642

Provider Business Practice Location Address
First Line	:	100 KIOWA DR W
Second Line	:	SUITE 301
City	:	LAKE KIOWA
State	:	TX
Zip	:	76240-9584
Country	:	US
Telephone Number	:	940-668-8755
Fax Number	:	940-222-6742

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	JAMI HAMILTON
Credential	:	D.C.
Telephone Number	:	940-668-8755

Provider Enumeration Date	:	04/12/2012
Last Update Date	:	05/08/2014

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