Provider Demographics
NPI:1215195292
Name:QUINN, JACQUELINE JO (DOM, LAC, LMT, DI)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:JO
Last Name:QUINN
Suffix:
Gender:F
Credentials:DOM, LAC, LMT, DI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 N. ALMA SCHOOL RD
Mailing Address - Street 2:UNIT 14
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201
Mailing Address - Country:US
Mailing Address - Phone:480-882-8385
Mailing Address - Fax:
Practice Address - Street 1:3014 N. HAYDEN RD
Practice Address - Street 2:SUITE 106A
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251
Practice Address - Country:US
Practice Address - Phone:480-882-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0580171100000X
NM1011171100000X
133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No133N00000XDietary & Nutritional Service ProvidersNutritionist