Provider Demographics
NPI:1396964565
Name:HUMBER, THOMAS M (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:HUMBER
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 1:820 EBENEZER CHURCH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-2073
Mailing Address - Country:US
Mailing Address - Phone:770-251-4345
Mailing Address - Fax:770-251-8072
Practice Address - Street 1:820 EBENEZER CHURCH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-2073
Practice Address - Country:US
Practice Address - Phone:770-251-4345
Practice Address - Fax:770-251-8072
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2813111N00000X
GACHIR001202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
145745OtherBCBS
GA35ZCGPQMedicare ID - Type Unspecified
GAU22310Medicare UPIN