Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CH0000001717 | WA |
NPI | 1043359102 |
---|---|
Provider Name | Dr. John Richard Quigley JR. |
First Address | Spanaway, WA 98387-4616 |
Second Address | Spanaway, WA 98387-4616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T02779 | (02) | WA |