Provider Demographics
NPI:1659489706
Name:QUINONES, MATTHEW JON (DC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JON
Last Name:QUINONES
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 1:5538 NEW CUT RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214
Mailing Address - Country:US
Mailing Address - Phone:502-380-1210
Mailing Address - Fax:502-380-1646
Practice Address - Street 1:5538 NEW CUT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214
Practice Address - Country:US
Practice Address - Phone:502-380-1210
Practice Address - Fax:502-380-1646
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY11513402OtherCAQH
50008038OtherPASSPORT
KY85003721Medicaid
KY000000382602OtherANTHEM BC/BS
7385725OtherAETNA
681979OtherGE WELLNESS
681979OtherHEALTH ALLIES
KY000000382602OtherANTHEM SENIOR ADVANTAGE
KY2446185000OtherPASSPORT ADVANTAGE
681979OtherGOLDEN RULE
681979OtherBLUEGRASS FAMILY HEALTH
681979OtherGREAT WEST HEALTHCARE
681979OtherGOLDEN RULE
681979OtherGREAT WEST HEALTHCARE