Provider Demographics
NPI:1326180738
Name:QUANDT, IRENE E (DC)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:E
Last Name:QUANDT
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:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:MONTELLO
Mailing Address - State:WI
Mailing Address - Zip Code:53949-0277
Mailing Address - Country:US
Mailing Address - Phone:608-297-7228
Mailing Address - Fax:608-297-7210
Practice Address - Street 1:65 W PARK STREET
Practice Address - Street 2:
Practice Address - City:MONTELLO
Practice Address - State:WI
Practice Address - Zip Code:53949-0277
Practice Address - Country:US
Practice Address - Phone:608-297-7228
Practice Address - Fax:608-297-7210
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T63047Medicare UPIN
WI000075856Medicare ID - Type Unspecified