Provider Demographics
NPI:1154523363
Name:HUFFSTETLER, CHRISTOPHER COLONEL (CPED, CO, CP)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:COLONEL
Last Name:HUFFSTETLER
Suffix:
Gender:M
Credentials:CPED, CO, CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-4849
Mailing Address - Country:US
Mailing Address - Phone:704-635-7201
Mailing Address - Fax:
Practice Address - Street 1:104 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4849
Practice Address - Country:US
Practice Address - Phone:704-635-7201
Practice Address - Fax:888-235-6928
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224P00000X, 222Z00000X
NCC46772335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795449Medicaid