Provider Demographics
NPI:1649350604
Name:HUFFMAN CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:HUFFMAN CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:SHANNON
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-453-6808
Mailing Address - Street 1:1695 MESQUITE AVE STE 114
Mailing Address - Street 2:
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 STE 114
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z1452OtherHEALTH NET
AZAZ0935770OtherBCBS AZ
AZAZ0935770OtherBCBS AZ
AZ70599Medicare ID - Type Unspecified