Provider Demographics
NPI:1154425700
Name:HUFF, CARROLL ROSS (DC)
Entity type:Individual
Prefix:
First Name:CARROLL
Middle Name:ROSS
Last Name:HUFF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 S. OAK ST
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MO
Mailing Address - Zip Code:65018-1462
Mailing Address - Country:US
Mailing Address - Phone:573-796-3777
Mailing Address - Fax:573-796-5043
Practice Address - Street 1:1116 S. OAK ST
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MO
Practice Address - Zip Code:65018-1462
Practice Address - Country:US
Practice Address - Phone:573-796-3777
Practice Address - Fax:573-796-5043
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U45250Medicare UPIN
MO000032451Medicare PIN
MOU45250Medicare UPIN
MO32451Medicare ID - Type Unspecified