Provider Demographics
NPI:1881833788
Name:QUINN, CHERIE R (TX LAC)
Entity Type:Individual
Prefix:MS
First Name:CHERIE
Middle Name:R
Last Name:QUINN
Suffix:
Gender:F
Credentials:TX LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 MONTCLAIR DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-2036
Mailing Address - Country:US
Mailing Address - Phone:817-341-7171
Mailing Address - Fax:
Practice Address - Street 1:1510 SANTA FE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5826
Practice Address - Country:US
Practice Address - Phone:817-341-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00413171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist