Healthcare Provider Details

I. General information

NPI: 1245243419
Provider Name (Legal Business Name): ANDERSON HAMO CHIROPRACTIC, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1174 W HILL RD SUITE 2
FLINT MI
48507-4776
US

IV. Provider business mailing address

1174 W HILL RD SUITE 2
FLINT MI
48507-4776
US

V. Phone/Fax

Practice location:
  • Phone: 810-238-9066
  • Fax: 810-238-9139
Mailing address:
  • Phone: 810-238-9066
  • Fax: 810-238-9139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number008894
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number008894
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number008899
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number008899
License Number StateMI

VIII. Authorized Official

Name: DR. TERA HAMO ANDERSON
Title or Position: MEMBER
Credential: D.C.
Phone: 810-238-9066