Provider Demographics
NPI:1023252921
Name:HIGGINBOTHAM, RICHARD GLENN (D,C)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GLENN
Last Name:HIGGINBOTHAM
Suffix:
Gender:M
Credentials:D,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 677662
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-7662
Mailing Address - Country:US
Mailing Address - Phone:630-468-1824
Mailing Address - Fax:630-701-1007
Practice Address - Street 1:190 E STACY RD
Practice Address - Street 2:SUITE 1614
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8734
Practice Address - Country:US
Practice Address - Phone:972-678-3080
Practice Address - Fax:972-678-3083
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor