Provider Demographics
NPI:1356983621
Name:HIGO, MINORU KENDRICK (DC)
Entity type:Individual
Prefix:
First Name:MINORU
Middle Name:KENDRICK
Last Name:HIGO
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 1:3315 E 47TH PL STE 120
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2911
Mailing Address - Country:US
Mailing Address - Phone:918-622-9655
Mailing Address - Fax:
Practice Address - Street 1:3315 E 47TH PL STE 120
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2911
Practice Address - Country:US
Practice Address - Phone:918-622-9655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor