MEDICARE: DR. DARRYL MICHAEL HUMENNY D.C.

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	111N00000X	Chiropractor	4512	MN

General Provider Information

NPI Number	:	1134167752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARRYL MICHAEL HUMENNY D.C.

Provider Business Mailing Address
First Line	:	2703 E LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1927
Country	:	US
Telephone Number	:	612-367-4030
Fax Number	:	612-367-4029

Provider Business Practice Location Address
First Line	:	2703 E LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406
Country	:	US
Telephone Number	:	612-367-4030
Fax Number	:	612-367-4029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	01/27/2012

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