Provider Demographics
NPI:1568848851
Name:DAHLQUIST, JANET
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:DAHLQUIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2557 CAPELLA DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-7140
Mailing Address - Country:US
Mailing Address - Phone:928-636-5956
Mailing Address - Fax:928-636-5956
Practice Address - Street 1:2557 CAPELLA DR
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-7140
Practice Address - Country:US
Practice Address - Phone:928-636-5956
Practice Address - Fax:928-636-5956
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMT-04952POtherMASSAGE THERAPIST