MEDICARE: DERRICK HAMILTON DC

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	038.012677	IL

General Provider Information

NPI Number	:	1629476452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERRICK HAMILTON DC

Provider Business Mailing Address
First Line	:	140 IOWA AVE
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62220-3940
Country	:	US
Telephone Number	:	618-416-1123
Fax Number	:	217-803-2485

Provider Business Practice Location Address
First Line	:	140 IOWA AVE STE 7
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62220-3940
Country	:	US
Telephone Number	:	618-416-1123
Fax Number	:	217-803-2485

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2014
Last Update Date	:	05/31/2022

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Directions to “ DERRICK HAMILTON DC” Practice Location

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