Provider Demographics
NPI:1568733780
Name:HUMPHREY, ABBY (DIPLAC)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3735
Mailing Address - Country:US
Mailing Address - Phone:734-216-3476
Mailing Address - Fax:
Practice Address - Street 1:2825 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3735
Practice Address - Country:US
Practice Address - Phone:734-216-3476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist