Provider Demographics
NPI:1073679148
Name:QUINTANA, FRED H (DC)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:H
Last Name:QUINTANA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 E 49TH ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1907
Mailing Address - Country:US
Mailing Address - Phone:305-681-2013
Mailing Address - Fax:305-681-0154
Practice Address - Street 1:755 E 49TH ST
Practice Address - Street 2:SUITE 10
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1907
Practice Address - Country:US
Practice Address - Phone:305-681-2013
Practice Address - Fax:305-681-0154
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55445Medicare ID - Type Unspecified