Provider Demographics
NPI:1699932848
Name:HUMBLE, JEFFERY JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:JOHN
Last Name:HUMBLE
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 1:1400 COLONIAL BLVD
Mailing Address - Street 2:SUITE 31
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1055
Mailing Address - Country:US
Mailing Address - Phone:239-989-7741
Mailing Address - Fax:
Practice Address - Street 1:1400 COLONIAL BLVD
Practice Address - Street 2:SUITE 31
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1055
Practice Address - Country:US
Practice Address - Phone:239-989-7741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88289OtherBLUE CROSS BLUE SHIELD