Provider Demographics
NPI:1699812289
Name:QUILLE, GREGORY (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:QUILLE
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 1:558 LAWRENCE SQUARE BLVD S
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2674
Mailing Address - Country:US
Mailing Address - Phone:609-585-6100
Mailing Address - Fax:
Practice Address - Street 1:558 LAWRENCE SQUARE BLVD S
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2674
Practice Address - Country:US
Practice Address - Phone:609-585-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00445200111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT44658Medicare UPIN
NJ096371Medicare ID - Type Unspecified