Provider Demographics
NPI:1558950485
Name:HUMPHREY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:HUMPHREY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-829-5216
Mailing Address - Street 1:400 W HIGHWAY 290 STE B203
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-4382
Mailing Address - Country:US
Mailing Address - Phone:614-296-2456
Mailing Address - Fax:
Practice Address - Street 1:400 W HIGHWAY 290 STE B203
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-4382
Practice Address - Country:US
Practice Address - Phone:614-296-2456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy