Provider Demographics
NPI:1275752412
Name:KQF INC
Entity Type:Organization
Organization Name:KQF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:FUSCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:434-293-6165
Mailing Address - Street 1:1006 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5374
Mailing Address - Country:US
Mailing Address - Phone:434-293-6165
Mailing Address - Fax:434-293-8765
Practice Address - Street 1:1006 E MARKET ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5374
Practice Address - Country:US
Practice Address - Phone:434-293-6165
Practice Address - Fax:434-293-8765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA22986400001OtherSOUTHERN HEALTH
VAT21778Medicare UPIN
VA350000027Medicare ID - Type Unspecified