Provider Demographics
NPI:1760541932
Name:HUMBER, DURIE DELANO JR (DC)
Entity Type:Individual
Prefix:DR
First Name:DURIE
Middle Name:DELANO
Last Name:HUMBER
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 BURKE ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3463
Mailing Address - Country:US
Mailing Address - Phone:770-389-4724
Mailing Address - Fax:678-272-4031
Practice Address - Street 1:165 BURKE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3463
Practice Address - Country:US
Practice Address - Phone:770-389-4724
Practice Address - Fax:678-272-4031
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5325111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA664098OtherUNITED HEALTH CARE
GAU63199Medicare ID - Type Unspecified