MEDICARE: DR. DAVID DEWEY HIGGINBOTHAM D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC5328	TX

General Provider Information

NPI Number	:	1154402386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID DEWEY HIGGINBOTHAM D.C.

Provider Business Mailing Address
First Line	:	4416 FAIRMONT PKWY
Second Line	:	SUITE 109
City	:	PASADENA
State	:	TX
Zip	:	77504-3327
Country	:	US
Telephone Number	:	281-487-4700
Fax Number	:	281-487-4750

Provider Business Practice Location Address
First Line	:	4416 FAIRMONT PKWY
Second Line	:	STE. 109
City	:	PASADENA
State	:	TX
Zip	:	77504-3327
Country	:	US
Telephone Number	:	281-487-4700
Fax Number	:	281-487-4750

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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