Provider Demographics
NPI:1114518990
Name:QERIQI, QENDRESA (DC)
Entity Type:Individual
Prefix:DR
First Name:QENDRESA
Middle Name:
Last Name:QERIQI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 MERROW RD
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-3935
Mailing Address - Country:US
Mailing Address - Phone:860-454-0942
Mailing Address - Fax:
Practice Address - Street 1:387 MERROW RD
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3935
Practice Address - Country:US
Practice Address - Phone:860-454-0942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002206111N00000X
NYX013411-01111N00000X
CT002209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty