Individual provider Active NPI

Jeffery John Humble, D.C.

  • Chiropractor
  • Fort Myers, FL
National Provider Identifier
1699932848
Registry record updated Feb 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH9359 Issued in FL
Practice address
1400 Colonial Blvd
Suite 31
Fort Myers, FL 33907-1055
Phone
(239) 989-7741
NPI assigned
May 16, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 11, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH9359 FL Primary

Addresses

Primary practice location

1400 Colonial Blvd
Suite 31
Fort Myers, FL 33907-1055

Mailing address

1400 Colonial Blvd
Suite 31
Fort Myers, FL 33907-1055
Phone (239) 989-7741

Other identifiers 1

IdentifierTypeStateIssuer
88289OtherFLBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091105000293 FL Practitioner - Chiropractic 2961540307 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6360 Presidential CT
Suite 4
Fort Myers, FL 33919-3501
Phone (239) 214-8578

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH9359FLMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Humble Chiropractic Inc Chiropractor CurrentSince Nov 5, 2014 Accepting new patients
James Todd Williams DC PA Chiropractor Past Accepting new patients
Southwest Spine and Sport, Inc. Chiropractor PastSince Apr 8, 2010 Accepting new patients

Locations

6360 Presidential Ct
Ste 4
Fort Myers, FL 33919
Phone (239) 437-1155

8695 College Pkwy
Ste 1041
Fort Myers, FL 33919
Phone (239) 214-8578

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265846400000",
    "number": "1699932848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 COLONIAL BLVD",
            "address_2": "SUITE 31",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339071055",
            "telephone_number": "239-989-7741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 COLONIAL BLVD",
            "address_2": "SUITE 31",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339071055",
            "telephone_number": "239-989-7741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMBLE",
        "first_name": "JEFFERY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-16",
        "last_updated": "2010-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH9359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "88289",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.