Provider Demographics
NPI:1720187644
Name:QUINTANILLA, JESUS (DC)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:QUINTANILLA
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 1:2727 MORGAN AVE
Mailing Address - Street 2:STE. 300
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-1821
Mailing Address - Country:US
Mailing Address - Phone:361-882-7502
Mailing Address - Fax:361-882-7528
Practice Address - Street 1:2727 MORGAN AVE
Practice Address - Street 2:STE. 300
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1821
Practice Address - Country:US
Practice Address - Phone:361-882-7502
Practice Address - Fax:361-882-7528
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8851111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F2663Medicare ID - Type Unspecified