Provider Demographics
NPI:1932682820
Name:HIGGINS WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:HIGGINS WELLNESS CENTER LLC
Other - Org Name:NEW LEAF CHIROPRACTIC WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRISON
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-605-9247
Mailing Address - Street 1:2029 OSPREY LN STE B
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-9361
Mailing Address - Country:US
Mailing Address - Phone:813-254-2500
Mailing Address - Fax:
Practice Address - Street 1:2029 OSPREY LN STE B
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-9361
Practice Address - Country:US
Practice Address - Phone:813-254-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CH12576111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty