MEDICARE: CORNELIUS CHIROPRACTIC 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	3980	OR

General Provider Information

NPI Number	:	1699005884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNELIUS CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	5035 NE ELAM YOUNG PKWY
Second Line	:	SUITE 300
City	:	HILLSBORO
State	:	OR
Zip	:	97124-6425
Country	:	US
Telephone Number	:	503-626-3700
Fax Number	:	503-643-6667

Provider Business Practice Location Address
First Line	:	5035 NE ELAM YOUNG PKWY
Second Line	:	SUITE 300
City	:	HILLSBORO
State	:	OR
Zip	:	97124-6425
Country	:	US
Telephone Number	:	503-626-3700
Fax Number	:	503-643-6667

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSEPH JACK HAMLIN
Credential	:	DC BS
Telephone Number	:	503-626-3700

Provider Enumeration Date	:	01/11/2010
Last Update Date	:	07/23/2015

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