Provider Demographics
NPI:1104331370
Name:HIGGINS KORKOW, CHRISTINA E
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:E
Last Name:HIGGINS KORKOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 W CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:GATES
Mailing Address - State:OR
Mailing Address - Zip Code:97346-9307
Mailing Address - Country:US
Mailing Address - Phone:503-409-1506
Mailing Address - Fax:
Practice Address - Street 1:2555 SILVERTON RD NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0837
Practice Address - Country:US
Practice Address - Phone:503-393-4273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW2253175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist