Provider Demographics
NPI:1184905390
Name:MORQUECHO, MONA-RAE L (DC)
Entity type:Individual
Prefix:DR
First Name:MONA-RAE
Middle Name:L
Last Name:MORQUECHO
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 1:12800 NE 4TH ST
Mailing Address - Street 2:MM121
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5051
Mailing Address - Country:US
Mailing Address - Phone:360-977-0580
Mailing Address - Fax:
Practice Address - Street 1:12800 NE 4TH ST
Practice Address - Street 2:MM121
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5051
Practice Address - Country:US
Practice Address - Phone:360-977-0580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60261750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor