Provider Demographics
NPI:1285965178
Name:HIGNITE, TIMOTHY L (DC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:L
Last Name:HIGNITE
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:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74821-0608
Mailing Address - Country:US
Mailing Address - Phone:580-436-9079
Mailing Address - Fax:580-436-8204
Practice Address - Street 1:931 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4055
Practice Address - Country:US
Practice Address - Phone:580-436-9079
Practice Address - Fax:580-436-8204
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-18
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor