Provider Demographics
NPI:1508802695
Name:MARQUARDT, HENRY CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:CHARLES
Last Name:MARQUARDT
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:PO BOX 4975
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-4975
Mailing Address - Country:US
Mailing Address - Phone:913-530-2889
Mailing Address - Fax:307-200-6639
Practice Address - Street 1:25 S GROS VENTRE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:913-530-2889
Practice Address - Fax:307-200-6639
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04793111N00000X
WY748111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS007492452OtherAETNA PIN
KS32234012OtherBLUECROSS BLUESHIELD PIN