Healthcare Provider Details

I. General information

NPI: 1215092770
Provider Name (Legal Business Name): LISA MARIE HUFFMAN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 W YAMATO RD
BOCA RATON FL
33431
US

IV. Provider business mailing address

166 W YAMATO RD
BOCA RATON FL
33431-4226
US

V. Phone/Fax

Practice location:
  • Phone: 561-314-4575
  • Fax: 561-431-2300
Mailing address:
  • Phone: 916-856-7708
  • Fax: 561-431-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7435
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 10856
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC28567
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: