MEDICARE: DR. CHARLES MICHAEL HIGUERA 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	X011466-1	NY

General Provider Information

NPI Number	:	1881843746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES MICHAEL HIGUERA D.C.

Provider Business Mailing Address
First Line	:	50 ROUTE 106
Second Line	:
City	:	JERICHO
State	:	NY
Zip	:	11753-1208
Country	:	US
Telephone Number	:	212-470-5270
Fax Number	:

Provider Business Practice Location Address
First Line	:	9205 ROCKAWAY BLVD
Second Line	:	FL 1
City	:	OZONE PARK
State	:	NY
Zip	:	11417-2428
Country	:	US
Telephone Number	:	347-475-0078
Fax Number	:

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

Provider Enumeration Date	:	09/16/2008
Last Update Date	:	05/26/2021

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