Provider Demographics
NPI:1881843746
Name:HIGUERA, CHARLES MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MICHAEL
Last Name:HIGUERA
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 1:50 ROUTE 106
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1208
Mailing Address - Country:US
Mailing Address - Phone:212-470-5270
Mailing Address - Fax:
Practice Address - Street 1:9205 ROCKAWAY BLVD
Practice Address - Street 2:FL 1
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-2428
Practice Address - Country:US
Practice Address - Phone:347-475-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011466-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor