Provider Demographics
NPI:1134111578
Name:HUFFAKER, LEON JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:JAY
Last Name:HUFFAKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 PLEASANT CIR
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4115
Mailing Address - Country:US
Mailing Address - Phone:801-358-5577
Mailing Address - Fax:801-434-9781
Practice Address - Street 1:1306 N STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2663
Practice Address - Country:US
Practice Address - Phone:801-358-5544
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT48625391202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor