Healthcare Provider Details

I. General information

NPI: 1124453410
Provider Name (Legal Business Name): MICAH HAMILTON CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23792 ROCKFIELD BLVD SUITE 210
LAKE FOREST CA
92630-2868
US

IV. Provider business mailing address

23792 ROCKFIELD BLVD SUITE 210
LAKE FOREST CA
92630-2868
US

V. Phone/Fax

Practice location:
  • Phone: 949-470-4757
  • Fax:
Mailing address:
  • Phone: 949-470-4757
  • Fax: 949-470-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC31333
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC31333
License Number StateCA

VIII. Authorized Official

Name: DR. MICAH STEPHEN HAMILTON
Title or Position: CEO
Credential: DC
Phone: 949-228-9311