Healthcare Provider Details

I. General information

NPI: 1336257781
Provider Name (Legal Business Name): CHRIS ALLEN HUMBLE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 E FRESNO AVE
PONCA CITY OK
74601-2817
US

IV. Provider business mailing address

508 E FRESNO AVE
PONCA CITY OK
74601-2817
US

V. Phone/Fax

Practice location:
  • Phone: 580-762-1122
  • Fax: 580-762-1157
Mailing address:
  • Phone: 580-762-1122
  • Fax: 580-762-1157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2416
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: