Provider Demographics
NPI:1346289949
Name:WEBB-BARRADAS-ATTA, CANTRESE MARCHAY (DC)
Entity Type:Individual
Prefix:MISS
First Name:CANTRESE
Middle Name:MARCHAY
Last Name:WEBB-BARRADAS-ATTA
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 1:700 15TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-2027
Mailing Address - Country:US
Mailing Address - Phone:309-757-7717
Mailing Address - Fax:309-757-7718
Practice Address - Street 1:700 15TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-2027
Practice Address - Country:US
Practice Address - Phone:309-757-7717
Practice Address - Fax:309-757-7718
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL910880Medicare ID - Type Unspecified