Provider Demographics
NPI:1043359102
Name:QUIGLEY, JOHN RICHARD JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD
Last Name:QUIGLEY
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:R
Other - Last Name:QUIGLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:129 176TH ST S STE A
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-4616
Mailing Address - Country:US
Mailing Address - Phone:253-539-0132
Mailing Address - Fax:
Practice Address - Street 1:129 176TH ST S STE A
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-4616
Practice Address - Country:US
Practice Address - Phone:253-539-0132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH0000001717111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT02779Medicare UPIN
WA0010000971Medicare ID - Type Unspecified