Provider Demographics
NPI:1992990725
Name:SHAD M. HUFFER, P.C.
Entity type:Organization
Organization Name:SHAD M. HUFFER, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAD
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:HUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-482-2923
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU78941Medicare UPIN
IN178840Medicare PIN