Provider Demographics
NPI:1760850325
Name:MADSEN, QUINTEN
Entity Type:Individual
Prefix:
First Name:QUINTEN
Middle Name:
Last Name:MADSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN GREEN
Mailing Address - State:UT
Mailing Address - Zip Code:84632-0036
Mailing Address - Country:US
Mailing Address - Phone:435-813-2577
Mailing Address - Fax:
Practice Address - Street 1:3800 W 3500 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-3306
Practice Address - Country:US
Practice Address - Phone:435-813-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9527752-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor