Provider Demographics
NPI:1184637373
Name:HUFFMAN, PAUL SHANNON (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:SHANNON
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 1:1695 MESQUITE AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5647
Mailing Address - Country:US
Mailing Address - Phone:928-453-6808
Mailing Address - Fax:928-453-8485
Practice Address - Street 1:1695 MESQUITE AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5647
Practice Address - Country:US
Practice Address - Phone:928-453-6808
Practice Address - Fax:928-453-8485
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0935770OtherBLUE CROSS BLUE SHIELD
AZ1Z1452OtherHEALTH NET
AZ350055273OtherRAILROAD MEDICARE
AZ1Z1452OtherHEALTH NET
AZU42214Medicare UPIN