Provider Demographics
NPI:1891165627
Name:HUMMEL, MICHAEL BLAINE (ND)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BLAINE
Last Name:HUMMEL
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 RUSSELL ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-7337
Mailing Address - Country:US
Mailing Address - Phone:541-488-3133
Mailing Address - Fax:541-488-6949
Practice Address - Street 1:478 RUSSELL ST STE 101
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-7337
Practice Address - Country:US
Practice Address - Phone:541-488-3133
Practice Address - Fax:541-488-6949
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16-1593175F00000X
OR4465175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath