Provider Demographics
NPI:1023515483
Name:ENCARNACION QUEZADA, MILTON (DC)
Entity type:Individual
Prefix:
First Name:MILTON
Middle Name:
Last Name:ENCARNACION QUEZADA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 W RANDOL MILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2564
Mailing Address - Country:US
Mailing Address - Phone:682-238-3801
Mailing Address - Fax:
Practice Address - Street 1:912 W RANDOL MILL RD STE A
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2564
Practice Address - Country:US
Practice Address - Phone:682-238-3801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor