Provider Demographics
NPI:1356469803
Name:HUMPHRIES, DONN ORIEN (DC)
Entity Type:Individual
Prefix:DR
First Name:DONN
Middle Name:ORIEN
Last Name:HUMPHRIES
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 1:4112 CRIMSON DR
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60195-1212
Mailing Address - Country:US
Mailing Address - Phone:847-359-2358
Mailing Address - Fax:
Practice Address - Street 1:690 N ROUTE 31
Practice Address - Street 2:SUITE F
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012
Practice Address - Country:US
Practice Address - Phone:815-356-6080
Practice Address - Fax:815-356-6082
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1682732OtherBLUE CROSS BLUE SHIELD
ILU17059Medicare UPIN
IL202159Medicare ID - Type Unspecified