MEDICARE: PETER HUMMEL

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	5687	NC

General Provider Information

NPI Number	:	1366215139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER HUMMEL

Provider Business Mailing Address
First Line	:	820 LAKE PARK DR APT 104
Second Line	:
City	:	DAVIDSON
State	:	NC
Zip	:	28036-5511
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19722 ONE NORMAN BLVD STE 210
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031-5911
Country	:	US
Telephone Number	:	980-689-2499
Fax Number	:

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

Provider Enumeration Date	:	11/03/2023
Last Update Date	:	11/03/2023

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Directions to “ PETER HUMMEL ” Practice Location

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