Provider Demographics
NPI:1679627194
Name:QUINTANA, GLENN VICENTE (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:VICENTE
Last Name:QUINTANA
Suffix:
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 1:8955 SW 87TH CT STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2264
Mailing Address - Country:US
Mailing Address - Phone:305-670-9313
Mailing Address - Fax:305-670-9313
Practice Address - Street 1:8955 SW 87TH CT STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2264
Practice Address - Country:US
Practice Address - Phone:305-670-9313
Practice Address - Fax:305-670-9313
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
22715Medicare ID - Type Unspecified