Provider Demographics
NPI:1114736923
Name:QUEVEDO, MARISA DAWN (DC)
Entity type:Individual
Prefix:DR
First Name:MARISA
Middle Name:DAWN
Last Name:QUEVEDO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8405 LAKEVIEW PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4559
Mailing Address - Country:US
Mailing Address - Phone:972-412-1150
Mailing Address - Fax:972-412-1160
Practice Address - Street 1:8405 LAKEVIEW PKWY STE 202
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4559
Practice Address - Country:US
Practice Address - Phone:972-412-1150
Practice Address - Fax:972-412-1160
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor