Provider Demographics
NPI:1699778654
Name:HUFFER, SHAD MITCHELL (DC)
Entity type:Individual
Prefix:DR
First Name:SHAD
Middle Name:MITCHELL
Last Name:HUFFER
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 1:502 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3503
Mailing Address - Country:US
Mailing Address - Phone:812-482-2923
Mailing Address - Fax:812-482-2934
Practice Address - Street 1:502 3RD AVE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3503
Practice Address - Country:US
Practice Address - Phone:812-482-2923
Practice Address - Fax:812-482-2934
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2008-12-18
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
IN08001895A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00641788OtherRRMR
IN178840Medicare ID - Type Unspecified
INP00641788OtherRRMR