Provider Demographics
NPI:1346492519
Name:HUMBLE CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:HUMBLE CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HUMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:580-762-1122
Mailing Address - Street 1:508 E FRESNO AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-2817
Mailing Address - Country:US
Mailing Address - Phone:580-762-1122
Mailing Address - Fax:580-762-1157
Practice Address - Street 1:508 E FRESNO AVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2817
Practice Address - Country:US
Practice Address - Phone:580-762-1122
Practice Address - Fax:580-762-1157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-18
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK75300Medicare UPIN