MEDICARE: PAUL SHANNON HUFFMAN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5112	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	350055273	OTHER	AZ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0935770	OTHER	AZ	BLUE CROSS BLUE SHIELD
2	1Z1452	OTHER	AZ	HEALTH NET

General Provider Information

NPI Number	:	1184637373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL SHANNON HUFFMAN D.C.

Provider Business Mailing Address
First Line	:	1695 MESQUITE AVE
Second Line	:	SUITE 114
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5647
Country	:	US
Telephone Number	:	928-453-6808
Fax Number	:	928-453-8485

Provider Business Practice Location Address
First Line	:	1695 MESQUITE AVE
Second Line	:	SUITE 114
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5647
Country	:	US
Telephone Number	:	928-453-6808
Fax Number	:	928-453-8485

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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