Provider Demographics
NPI:1083680698
Name:QUINONES, MARCEL (DC)
Entity type:Individual
Prefix:
First Name:MARCEL
Middle Name:
Last Name:QUINONES
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 1:14601 WOODSTREAM PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5165
Mailing Address - Country:US
Mailing Address - Phone:502-244-4646
Mailing Address - Fax:502-244-4402
Practice Address - Street 1:7401 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-2755
Practice Address - Country:US
Practice Address - Phone:502-962-8700
Practice Address - Fax:502-962-8714
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4145111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85036465Medicaid
KY85036465Medicaid
KY0907601Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #