Provider Demographics
NPI:1467537803
Name:DAVID TODD QUIBELL
Entity Type:Organization
Organization Name:DAVID TODD QUIBELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:QUIBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:660-747-7171
Mailing Address - Street 1:407 A. EAST RUSSELL
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093
Mailing Address - Country:US
Mailing Address - Phone:660-747-7171
Mailing Address - Fax:
Practice Address - Street 1:407A E RUSSELL AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-1242
Practice Address - Country:US
Practice Address - Phone:660-747-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006208261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0005888Medicare PIN