Provider Demographics
NPI:1134139207
Name:HUFFMAN, JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:HUFFMAN
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 1:1701 SHEPHERD RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-2179
Mailing Address - Country:US
Mailing Address - Phone:863-646-5575
Mailing Address - Fax:863-648-4465
Practice Address - Street 1:1701 SHEPHERD RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-2179
Practice Address - Country:US
Practice Address - Phone:863-646-5575
Practice Address - Fax:863-648-4465
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU90255Medicare UPIN
IL205577Medicare ID - Type Unspecified