Provider Demographics
NPI:1295778488
Name:HABIGHORST, RICHARD G (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:HABIGHORST
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 1:1981 MIDWAY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-7001
Mailing Address - Country:US
Mailing Address - Phone:920-882-7292
Mailing Address - Fax:
Practice Address - Street 1:1981 MIDWAY RD
Practice Address - Street 2:SUITE A
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-7001
Practice Address - Country:US
Practice Address - Phone:920-882-7292
Practice Address - Fax:920-882-8973
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38824900Medicaid
391451676012OtherBLUECROSS & BLUESHEILD
WIT62088Medicare UPIN
WI000035639Medicare ID - Type Unspecified