Provider Demographics
NPI:1265753354
Name:HUMPHRIES, TYRONE (LAC)
Entity type:Individual
Prefix:MR
First Name:TYRONE
Middle Name:
Last Name:HUMPHRIES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-683 S MEA LANAKILA PL
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-7914
Mailing Address - Country:US
Mailing Address - Phone:808-936-6281
Mailing Address - Fax:808-326-9858
Practice Address - Street 1:75-5626 KUAKINI HWY STE 20
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3116
Practice Address - Country:US
Practice Address - Phone:808-936-6281
Practice Address - Fax:808-326-9858
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-12
Last Update Date:2010-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU-584171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist