Provider Demographics
NPI:1528366499
Name:MCQUEEN, WILLIAM RONALD (LMT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RONALD
Last Name:MCQUEEN
Suffix:
Gender:M
Credentials:LMT
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 5039
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-5039
Mailing Address - Country:US
Mailing Address - Phone:719-395-7807
Mailing Address - Fax:
Practice Address - Street 1:301 E. MAIN ST.
Practice Address - Street 2:SUITE 26
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-5039
Practice Address - Country:US
Practice Address - Phone:719-395-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1006172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist