=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881843746
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES MICHAEL HIGUERA D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2008
-----------------------------------------------------
Last Update Date | 05/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9205 ROCKAWAY BLVD FL 1
-----------------------------------------------------
City | OZONE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11417-2428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-475-0078
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 ROUTE 106
-----------------------------------------------------
City | JERICHO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11753-1208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-470-5270
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | X011466-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------