Provider Demographics
NPI:1558461491
Name:QUINN, DIANE TELLIER (D C)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:TELLIER
Last Name:QUINN
Suffix:
Gender:F
Credentials:D C
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:BARBARA
Other - Last Name:TELLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:208 HURRICANE DR
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32433-7143
Mailing Address - Country:US
Mailing Address - Phone:850-520-5152
Mailing Address - Fax:
Practice Address - Street 1:208 HURRICANE DR
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32433-7143
Practice Address - Country:US
Practice Address - Phone:850-520-5152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006349111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU44489Medicare UPIN
FL22920Medicare ID - Type Unspecified