Healthcare Provider Details

I. General information

NPI: 1023101029
Provider Name (Legal Business Name): MARC C HAMILTON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 COMMERCENTER EAST SUITE 112
SAN BERNARDINO CA
92408-3442
US

IV. Provider business mailing address

P.O. BOX 351
SAN BERNARDINO CA
92402-0351
US

V. Phone/Fax

Practice location:
  • Phone: 909-890-1888
  • Fax: 909-890-0196
Mailing address:
  • Phone: 909-890-1888
  • Fax: 909-890-0196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC21345
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC21345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: