MEDICARE: DR. MARK A HUMINSKI DC

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	1208	SC
2	111NN0400X	Neurology Chiropractor	1208	SC

General Provider Information

NPI Number	:	1659371912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A HUMINSKI DC

Provider Business Mailing Address
First Line	:	365A E BLACKSTOCK RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-3762
Country	:	US
Telephone Number	:	864-574-4862
Fax Number	:	864-587-6858

Provider Business Practice Location Address
First Line	:	365A E BLACKSTOCK RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-3762
Country	:	US
Telephone Number	:	864-574-4862
Fax Number	:	864-587-6858

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	08/24/2010

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Directions to “ DR. MARK A HUMINSKI DC” Practice Location

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