MEDICARE: DR. JEFFERY JOHN HUMBLE 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	CH9359	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88289	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1699932848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY JOHN HUMBLE D.C.

Provider Business Mailing Address
First Line	:	1400 COLONIAL BLVD
Second Line	:	SUITE 31
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1055
Country	:	US
Telephone Number	:	239-989-7741
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 COLONIAL BLVD
Second Line	:	SUITE 31
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1055
Country	:	US
Telephone Number	:	239-989-7741
Fax Number	:

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

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	02/11/2010

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