Provider Demographics
NPI:1437276342
Name:DANCE, QUCHYAL LEI (LMT)
Entity Type:Individual
Prefix:
First Name:QUCHYAL
Middle Name:LEI
Last Name:DANCE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:QUCHYAL
Other - Middle Name:LEI
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:680 ROBMAR LN
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-8936
Mailing Address - Country:US
Mailing Address - Phone:541-226-7605
Mailing Address - Fax:541-479-8621
Practice Address - Street 1:141 SW G ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2413
Practice Address - Country:US
Practice Address - Phone:541-479-8621
Practice Address - Fax:541-479-8621
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3584174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist