Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2000145882 | MO |
NPI | 1003907064 |
---|---|
Provider Name | Dr. Quinn Joseph James |
First Address | Saint Peters, MO 63304-7441 |
Second Address | Saint Peters, MO 63304-7441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 10/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U79154 | (02) | MO |