MEDICARE: DILLON HUMPHRIES

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	CH14475	FL

General Provider Information

NPI Number	:	1861241523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DILLON HUMPHRIES

Provider Business Mailing Address
First Line	:	1436 LONE WOOD BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-5011
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1436 LONE WOOD BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-5011
Country	:	US
Telephone Number	:	321-514-7607
Fax Number	:

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

Provider Enumeration Date	:	05/15/2024
Last Update Date	:	05/15/2024

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Directions to “ DILLON HUMPHRIES ” Practice Location

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