MEDICARE: DR. KENNETH WAYNE HAMMON D.C.

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	CH6564	FL

General Provider Information

NPI Number	:	1922164102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH WAYNE HAMMON D.C.

Provider Business Mailing Address
First Line	:	10311 CROSS CREEK BLVD
Second Line	:	STE E
City	:	TAMPA
State	:	FL
Zip	:	33647-2989
Country	:	US
Telephone Number	:	727-791-0099
Fax Number	:	727-791-2257

Provider Business Practice Location Address
First Line	:	10311 CROSS CREEK BLVD
Second Line	:	STE E
City	:	TAMPA
State	:	FL
Zip	:	33647-2989
Country	:	US
Telephone Number	:	727-791-0099
Fax Number	:	727-791-2257

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

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	03/22/2017

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