Provider Demographics
NPI:1194837245
Name:HIGGINS, WILLIAM BARDON (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BARDON
Last Name:HIGGINS
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 1:2525 E SELTICE WAY
Mailing Address - Street 2:STE C
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854
Mailing Address - Country:US
Mailing Address - Phone:208-777-7463
Mailing Address - Fax:208-777-9659
Practice Address - Street 1:2525 E SELTICE WAY
Practice Address - Street 2:STE C
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854
Practice Address - Country:US
Practice Address - Phone:208-777-7463
Practice Address - Fax:208-777-9659
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA982111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC4322OtherBLUE CROSS OF ID
ID10148527OtherBLUE SHIELD REGENCE
1674937Medicare ID - Type Unspecified