Provider Demographics
NPI:1275831760
Name:HUMMERT, BRETTANY LEE (DC)
Entity Type:Individual
Prefix:MRS
First Name:BRETTANY
Middle Name:LEE
Last Name:HUMMERT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:23 N GORE AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2300
Mailing Address - Country:US
Mailing Address - Phone:314-991-5655
Mailing Address - Fax:314-991-4872
Practice Address - Street 1:23 N GORE AVE
Practice Address - Street 2:STE 210
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2300
Practice Address - Country:US
Practice Address - Phone:314-991-5655
Practice Address - Fax:314-991-4872
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011012849111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor