Provider Demographics
NPI:1831647627
Name:HEALTH QUEST INTERNATIONAL
Entity Type:Organization
Organization Name:HEALTH QUEST INTERNATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGENER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:509-527-1156
Mailing Address - Street 1:2316 EASTGATE ST STE 110
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-1576
Mailing Address - Country:US
Mailing Address - Phone:509-527-1156
Mailing Address - Fax:506-522-4933
Practice Address - Street 1:2316 EASTGATE ST STE 110
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1576
Practice Address - Country:US
Practice Address - Phone:509-527-1156
Practice Address - Fax:506-522-4933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60656571261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation