Provider Demographics
NPI:1154402386
Name:HIGGINBOTHAM, DAVID DEWEY (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DEWEY
Last Name:HIGGINBOTHAM
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 1:4416 FAIRMONT PKWY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-3327
Mailing Address - Country:US
Mailing Address - Phone:281-487-4700
Mailing Address - Fax:281-487-4750
Practice Address - Street 1:4416 FAIRMONT PKWY
Practice Address - Street 2:STE. 109
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-3327
Practice Address - Country:US
Practice Address - Phone:281-487-4700
Practice Address - Fax:281-487-4750
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603284Medicare ID - Type Unspecified
TXU05757Medicare UPIN