Provider Demographics
NPI:1811010572
Name:QUICK, SALLY A (DC, PLLC)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:QUICK
Suffix:
Gender:F
Credentials:DC, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5610
Mailing Address - Country:US
Mailing Address - Phone:520-408-5287
Mailing Address - Fax:520-690-0266
Practice Address - Street 1:4715 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5610
Practice Address - Country:US
Practice Address - Phone:520-408-5287
Practice Address - Fax:520-690-0266
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ663627OtherAM CHIROPRACTIC NETWORK
AZ124149OtherHEALTHNET INS COMPANY
AZAZ0945040OtherBLUECROSS BLUE SHIELD
AZ4701OtherAZ CHIROPRACTIC LICENSE
AZAZ0945040OtherBLUECROSS BLUE SHIELD
AZU62601Medicare UPIN