Provider Demographics
NPI:1518150853
Name:HEALTHQUEST WELLNESS CENTER PSC
Entity Type:Organization
Organization Name:HEALTHQUEST WELLNESS CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:NEWCOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-965-2600
Mailing Address - Street 1:913 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:KY
Mailing Address - Zip Code:42064-1923
Mailing Address - Country:US
Mailing Address - Phone:270-965-2600
Mailing Address - Fax:270-965-2640
Practice Address - Street 1:913 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:KY
Practice Address - Zip Code:42064-1923
Practice Address - Country:US
Practice Address - Phone:270-965-2600
Practice Address - Fax:270-965-2640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4921111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9571Medicare PIN