Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 3041-012 | WI |
NPI | 1619974698 |
---|---|
Provider Name | Dr. Christopher Jon Hammer |
First Address | Milton, WI 53563-3720 |
Second Address | Milton, WI 53563-3720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
391834815014 | BLUE CROSS BLUE SHIELD (01) | WI |
546653 | DEAN CARE (01) | WI |
U50392 | (02) | WI |