Provider Demographics
NPI:1164523502
Name:HUMBERSTONE, LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:HUMBERSTONE
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 1:303 E ARMY TRAIL RD
Mailing Address - Street 2:STE 101
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2169
Mailing Address - Country:US
Mailing Address - Phone:630-529-2225
Mailing Address - Fax:630-529-0137
Practice Address - Street 1:303 E ARMY TRAIL RD
Practice Address - Street 2:STE 101
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2155
Practice Address - Country:US
Practice Address - Phone:630-529-2225
Practice Address - Fax:630-529-0137
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005562111N00000X
MI1123787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T38525Medicare UPIN
IL751880Medicare UPIN