Healthcare Provider Details

I. General information

NPI: 1346492519
Provider Name (Legal Business Name): HUMBLE CHIROPRACTIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2008
Last Update Date: 10/27/2010
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 Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRIS ALLEN HUMBLE
Title or Position: OWNER
Credential: D.C.
Phone: 580-762-1122