Provider Demographics
NPI:1871770115
Name:HIGGINBOTHAM CHIROPRACTIC
Entity type:Organization
Organization Name:HIGGINBOTHAM CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:HIGGINBOTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:318-251-2424
Mailing Address - Street 1:712 N TRENTON ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3324
Mailing Address - Country:US
Mailing Address - Phone:318-251-2424
Mailing Address - Fax:318-251-9922
Practice Address - Street 1:712 N TRENTON ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3324
Practice Address - Country:US
Practice Address - Phone:318-251-2424
Practice Address - Fax:318-251-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5D586Medicare PIN