Provider Demographics
NPI:1164831517
Name:HUMPHREY, CHERYL JEANINE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:JEANINE
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-3025
Mailing Address - Country:US
Mailing Address - Phone:510-432-2924
Mailing Address - Fax:
Practice Address - Street 1:210 E 20TH ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-3025
Practice Address - Country:US
Practice Address - Phone:510-432-2924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2014-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor