Provider Demographics
NPI:1831756089
Name:HIGGINS, JAY THOMAS (DC)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:THOMAS
Last Name:HIGGINS
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 1:8288 REVELWOOD PL
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-1534
Mailing Address - Country:US
Mailing Address - Phone:612-747-3309
Mailing Address - Fax:
Practice Address - Street 1:2119 CLIFF RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2345
Practice Address - Country:US
Practice Address - Phone:651-688-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6617111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor