Provider Demographics
NPI:1710299417
Name:QUALLS, JONATHON (DC)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:
Last Name:QUALLS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JON
Other - Middle Name:
Other - Last Name:QUALLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:450 S CAMINO DEL RIO STE 206
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-6857
Mailing Address - Country:US
Mailing Address - Phone:970-385-8585
Mailing Address - Fax:970-385-8584
Practice Address - Street 1:1415 W AZTEC BLVD STE 4
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-1899
Practice Address - Country:US
Practice Address - Phone:505-334-5004
Practice Address - Fax:970-385-8584
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor