Provider Demographics
NPI:1386788693
Name:QUEZADA, DONNA M (DC)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:QUEZADA
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 1:28801 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
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8851623Medicare ID - Type Unspecified
WAU61093Medicare UPIN