Provider Demographics
NPI:1821008848
Name:MARQUESS, JILL ALIX (DC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ALIX
Last Name:MARQUESS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4923 US ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:VT
Mailing Address - Zip Code:05158
Mailing Address - Country:US
Mailing Address - Phone:802-722-4023
Mailing Address - Fax:802-711-4137
Practice Address - Street 1:4923 US ROUTE 5
Practice Address - Street 2:SOJOURNS COMMUNITY HEALTH CLINIC
Practice Address - City:WESTMINSTER
Practice Address - State:VT
Practice Address - Zip Code:05158
Practice Address - Country:US
Practice Address - Phone:802-722-4023
Practice Address - Fax:802-711-4137
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0060001111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN3032Medicaid
10907153OtherCAQH
VT59116OtherBCBS
VT0VN3032Medicaid
VN3032Medicare ID - Type Unspecified