Provider Demographics
NPI:1215092770
Name:HUFFMAN, LISA MARIE (DC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 W YAMATO RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4226
Mailing Address - Country:US
Mailing Address - Phone:916-856-7708
Mailing Address - Fax:561-431-2300
Practice Address - Street 1:166 W YAMATO RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-314-4575
Practice Address - Fax:561-431-2300
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7435111N00000X
FLCH 10856111N00000X
CADC28567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZV04415Medicare UPIN
AZ107048Medicare ID - Type Unspecified