Provider Demographics
NPI:1396803771
Name:FAMILY HEALTH QUEST, SC
Entity type:Organization
Organization Name:FAMILY HEALTH QUEST, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-235-2301
Mailing Address - Street 1:640 W SOUTH ST # 1
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-6838
Mailing Address - Country:US
Mailing Address - Phone:815-235-2301
Mailing Address - Fax:815-297-8431
Practice Address - Street 1:640 W SOUTH ST # 1
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-6838
Practice Address - Country:US
Practice Address - Phone:815-235-2301
Practice Address - Fax:815-297-8431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208302Medicare ID - Type Unspecified
IL200395Medicare ID - Type Unspecified