Provider Demographics
NPI:1174744668
Name:HAMBACH, WILLIAM T (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
Last Name:HAMBACH
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 1:715 LAKE ST.
Mailing Address - Street 2:220
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301
Mailing Address - Country:US
Mailing Address - Phone:708-660-0148
Mailing Address - Fax:708-660-0151
Practice Address - Street 1:715 LAKE ST.
Practice Address - Street 2:220
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301
Practice Address - Country:US
Practice Address - Phone:708-660-0148
Practice Address - Fax:708-660-0151
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor