Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 090614 | IA |
NPI | 1003319922 |
---|---|
Provider Name | Quentin Danner |
First Address | Urbandale, IA 50323-2563 |
Second Address | Grimes, IA 50111-8901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2018 |
Last Update Date | 31/05/2018 |