Provider Demographics
NPI:1528457983
Name:QUINT CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:QUINT CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:QUINT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-225-2299
Mailing Address - Street 1:2000 N 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2305
Mailing Address - Country:US
Mailing Address - Phone:620-225-2299
Mailing Address - Fax:620-225-2378
Practice Address - Street 1:2000 N 14TH AVE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2305
Practice Address - Country:US
Practice Address - Phone:620-225-2299
Practice Address - Fax:620-225-2378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS660052001OtherMEDICARE PTAN