Provider Demographics
NPI:1659426336
Name:HIGGINBOTTOM, ROBERT VAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:VAN
Last Name:HIGGINBOTTOM
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 1:1740 E 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-5982
Mailing Address - Country:US
Mailing Address - Phone:773-667-9053
Mailing Address - Fax:773-667-9084
Practice Address - Street 1:1746 E 55TH STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615
Practice Address - Country:US
Practice Address - Phone:773-667-9053
Practice Address - Fax:773-667-9084
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
20995Medicare ID - Type Unspecified
U87903Medicare UPIN
K10622Medicare ID - Type Unspecified