Provider Demographics
NPI:1538131347
Name:QUINN, JOHN ROGER I (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROGER
Last Name:QUINN
Suffix:I
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S HALCYON RD
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3117
Mailing Address - Country:US
Mailing Address - Phone:805-481-9696
Mailing Address - Fax:805-481-4541
Practice Address - Street 1:207 S HALCYON RD
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3117
Practice Address - Country:US
Practice Address - Phone:805-481-9696
Practice Address - Fax:805-481-4541
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22441111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU60954Medicare UPIN