Provider Demographics
NPI:1073919585
Name:QUINTANILLA, MANUEL J (LMT, AC)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:J
Last Name:QUINTANILLA
Suffix:
Gender:M
Credentials:LMT, AC
Other - Prefix:
Other - First Name:MUQI
Other - Middle Name:
Other - Last Name:QUINTANILLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 W 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010-3208
Mailing Address - Country:US
Mailing Address - Phone:918-408-6997
Mailing Address - Fax:
Practice Address - Street 1:9242 S SHERIDAN RD
Practice Address - Street 2:SUITE 209
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5435
Practice Address - Country:US
Practice Address - Phone:918-408-6997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist