Healthcare Provider Details

I. General information

NPI: 1710438403
Provider Name (Legal Business Name): BRIAN E HUFFMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12995 S CLEVELAND AVE SUITE 253
FORT MYERS FL
33907-3890
US

IV. Provider business mailing address

12995 S CLEVELAND AVE SUITE 253
FORT MYERS FL
33907-3890
US

V. Phone/Fax

Practice location:
  • Phone: 239-482-5446
  • Fax:
Mailing address:
  • Phone: 239-482-5446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH11905
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: