Provider Demographics
NPI:1447248612
Name:HAMBRICK, LAWRENCE VINCENT (DC)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:VINCENT
Last Name:HAMBRICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 ALEXANDRIA PIKE
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:KY
Mailing Address - Zip Code:41076-1918
Mailing Address - Country:US
Mailing Address - Phone:859-441-7333
Mailing Address - Fax:859-441-5136
Practice Address - Street 1:4310 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076-1918
Practice Address - Country:US
Practice Address - Phone:859-441-7333
Practice Address - Fax:859-441-5136
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYT54451Medicare UPIN
KY6043601Medicare ID - Type Unspecified