Provider Demographics
NPI:1801857479
Name:QUINN, MARK ERIC (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ERIC
Last Name:QUINN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:479 OLD BOILING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-1960
Mailing Address - Country:US
Mailing Address - Phone:864-578-0012
Mailing Address - Fax:864-578-9991
Practice Address - Street 1:479 OLD BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-1960
Practice Address - Country:US
Practice Address - Phone:864-578-0012
Practice Address - Fax:864-578-9991
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCH2654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH408Medicaid
SCGCH408Medicaid