Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 2416 | OK |
NPI | 1336257781 |
---|---|
Provider Name | Dr. Chris Allen Humble |
First Address | Ponca City, OK 74601-2817 |
Second Address | Ponca City, OK 74601-2817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2006 |
Last Update Date | 26/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
75300 | (02) |