Provider Demographics
NPI:1891970141
Name:HOEFFNER, JOHN M (BS DC BCAO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:HOEFFNER
Suffix:
Gender:M
Credentials:BS DC BCAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 MALL BLVD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-0539
Mailing Address - Country:US
Mailing Address - Phone:912-264-8480
Mailing Address - Fax:912-264-8514
Practice Address - Street 1:712 MALL BLVD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-0539
Practice Address - Country:US
Practice Address - Phone:912-264-8480
Practice Address - Fax:912-264-8514
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV08005Medicare UPIN
GA35ZCJMHMedicare PIN