Provider Demographics
NPI:1063511996
Name:DEQUEVEDO, NESTOR GARCIA (DC)
Entity type:Individual
Prefix:DR
First Name:NESTOR
Middle Name:GARCIA
Last Name:DEQUEVEDO
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 1:98 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:PA
Mailing Address - Zip Code:18641-2228
Mailing Address - Country:US
Mailing Address - Phone:570-451-3404
Mailing Address - Fax:570-451-3407
Practice Address - Street 1:98 GROVE ST
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:PA
Practice Address - Zip Code:18641-2228
Practice Address - Country:US
Practice Address - Phone:570-451-3404
Practice Address - Fax:570-451-3407
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 008824111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAV0056Medicare UPIN
PA092254Medicare ID - Type Unspecified