Provider Demographics
NPI:1194010603
Name:QUAST, SEAN CAMERON (DC)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:CAMERON
Last Name:QUAST
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 1:3607 WHITE BEAR AVE N
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4744
Mailing Address - Country:US
Mailing Address - Phone:651-777-2225
Mailing Address - Fax:
Practice Address - Street 1:1591 COUNTY ROAD H2
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-6401
Practice Address - Country:US
Practice Address - Phone:651-777-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor