Provider Demographics
NPI:1902968621
Name:HUMFELD FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:HUMFELD FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUMFELD-WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-333-5388
Mailing Address - Street 1:119 CENTRAL AVE N
Mailing Address - Street 2:P.O. BOX 893
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5210
Mailing Address - Country:US
Mailing Address - Phone:507-333-5388
Mailing Address - Fax:507-333-5451
Practice Address - Street 1:119 CENTRAL AVE N
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5210
Practice Address - Country:US
Practice Address - Phone:507-333-5388
Practice Address - Fax:507-333-5451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-16
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN080M0HUOtherBCBS
MN872833000OtherDSHS
MN872833000OtherDSHS