Provider Demographics
NPI:1679181648
Name:QUINN, SIERRA (DC)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:QUINN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177145 HIGHWAY 277
Mailing Address - Street 2:
Mailing Address - City:GERONIMO
Mailing Address - State:OK
Mailing Address - Zip Code:73543-5211
Mailing Address - Country:US
Mailing Address - Phone:580-695-7599
Mailing Address - Fax:
Practice Address - Street 1:177145 HIGHWAY 277
Practice Address - Street 2:
Practice Address - City:GERONIMO
Practice Address - State:OK
Practice Address - Zip Code:73543-5211
Practice Address - Country:US
Practice Address - Phone:580-678-9998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor