Healthcare Provider Details

I. General information

NPI: 1699778654
Provider Name (Legal Business Name): SHAD MITCHELL HUFFER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/20/2006

III. Provider practice location address

502 3RD AVE
JASPER IN
47546-3503
US

IV. Provider business mailing address

502 3RD AVE
JASPER IN
47546-3503
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-2923
  • Fax: 812-482-2934
Mailing address:
  • Phone: 812-482-2923
  • Fax: 812-482-2934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001895A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: