Healthcare Provider Details

I. General information

NPI: 1780731554
Provider Name (Legal Business Name): TINA HUFFSTUTLER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 HIGHWAY 77
SOUTHSIDE AL
35907-0408
US

IV. Provider business mailing address

1514 HIGHWAY 77
SOUTHSIDE AL
35907-0408
US

V. Phone/Fax

Practice location:
  • Phone: 256-413-3098
  • Fax: 256-413-7884
Mailing address:
  • Phone: 256-413-3098
  • Fax: 256-413-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1522
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: