Provider Demographics
NPI:1003133893
Name:HUMPHREY, WILLIAM RICHARD II (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RICHARD
Last Name:HUMPHREY
Suffix:II
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 1:5615 PERSHING
Mailing Address - Street 2:SUITE 22
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112
Mailing Address - Country:US
Mailing Address - Phone:314-454-0566
Mailing Address - Fax:314-454-9406
Practice Address - Street 1:5615 PERSHING
Practice Address - Street 2:SUITE 22
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112
Practice Address - Country:US
Practice Address - Phone:314-454-0566
Practice Address - Fax:314-454-9406
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005279111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor