=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881870384
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUFFMAN CHIROPRACTIC, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2008
-----------------------------------------------------
Last Update Date | 01/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 319 BLUE TAIL DR
-----------------------------------------------------
City | HUFFMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77336-2801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-623-9796
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 319 BLUE TAIL DR
-----------------------------------------------------
City | HUFFMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77336-2801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CHARLES BARDWELL
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 832-623-9796
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 8229
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------