Provider Demographics
NPI:1154522068
Name:BIGGS, TY D (DC)
Entity type:Individual
Prefix:
First Name:TY
Middle Name:D
Last Name:BIGGS
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 1:300 SMALL ST
Mailing Address - Street 2:STE. 3
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-3325
Mailing Address - Country:US
Mailing Address - Phone:618-252-5555
Mailing Address - Fax:618-252-2279
Practice Address - Street 1:300 SMALL ST
Practice Address - Street 2:STE. 3
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-3325
Practice Address - Country:US
Practice Address - Phone:618-252-5555
Practice Address - Fax:618-252-2279
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010955111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038-010955OtherLICENSE NUMBER
K39520Medicare PIN