MEDICARE: HUMPHREY CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1558950485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUMPHREY CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	400 W HIGHWAY 290 STE B203
Second Line	:
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-4382
Country	:	US
Telephone Number	:	614-296-2456
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 W HIGHWAY 290 STE B203
Second Line	:
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-4382
Country	:	US
Telephone Number	:	614-296-2456
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JACKSON HUMPHREY
Credential	:	DC
Telephone Number	:	512-829-5216

Provider Enumeration Date	:	01/14/2021
Last Update Date	:	01/14/2021

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