Healthcare Provider Details

I. General information

NPI: 1942694534
Provider Name (Legal Business Name): DUSTIN JOHN HUFFMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 08/02/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 SR 436 STE 1001
CASSELBERRY FL
32707-5103
US

IV. Provider business mailing address

853 SR 436 SUITE 1001
CASSELBERRY FL
32707-5103
US

V. Phone/Fax

Practice location:
  • Phone: 140-796-0323
  • Fax: 407-960-3229
Mailing address:
  • Phone: 140-796-0323
  • Fax: 407-960-3229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 11460
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: