Provider Demographics
NPI:1366086530
Name:QUEZADA ENTERPRISES INC
Entity type:Organization
Organization Name:QUEZADA ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:QUEZADA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-825-1344
Mailing Address - Street 1:28801 SE 480TH ST
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-9357
Mailing Address - Country:US
Mailing Address - Phone:360-825-1344
Mailing Address - Fax:360-802-2442
Practice Address - Street 1:28801 SE 480TH ST
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-9357
Practice Address - Country:US
Practice Address - Phone:360-825-1344
Practice Address - Fax:360-802-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty