Provider Demographics
NPI:1528606837
Name:KENDRICK M. HIGO DC, PLLC
Entity Type:Organization
Organization Name:KENDRICK M. HIGO DC, PLLC
Other - Org Name:KENDRICK M. HIGO, DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE AND BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUELLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-622-9655
Mailing Address - Street 1:3315 E 47TH PLACE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135
Mailing Address - Country:US
Mailing Address - Phone:918-622-9655
Mailing Address - Fax:918-622-9657
Practice Address - Street 1:3315 E 47TH PL STE 120
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2911
Practice Address - Country:US
Practice Address - Phone:918-622-9655
Practice Address - Fax:918-622-9657
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TERRY R TATUM, DC, PC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-17
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty