Provider Demographics
NPI:1104899202
Name:HUMBER, STEVEN M
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:HUMBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 WISTERIA DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6191
Mailing Address - Country:US
Mailing Address - Phone:770-979-8327
Mailing Address - Fax:770-979-8338
Practice Address - Street 1:2336 WISTERIA DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6191
Practice Address - Country:US
Practice Address - Phone:770-979-8327
Practice Address - Fax:770-979-8338
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7324111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAT97668Medicare UPIN