Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC 009420 | PA |
NPI | 1114091063 |
---|---|
Provider Name | Dr. Paul G. Quinn |
First Address | Paoli, PA 19301-1505 |
Second Address | King Of Prussia, PA 19406-2802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2409290000 | INDEPENDENCE BC BS NO (01) | PA |