Provider Demographics
NPI:1811191596
Name:QUARTERSON, KYLEE LUCILLE
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:LUCILLE
Last Name:QUARTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 CLEVER RD
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-1023
Mailing Address - Country:US
Mailing Address - Phone:412-494-5440
Mailing Address - Fax:
Practice Address - Street 1:534 CLEVER RD
Practice Address - Street 2:
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-1023
Practice Address - Country:US
Practice Address - Phone:412-494-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC8621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1346010OtherHIGMARK PROVIDER NUMBER
PA1346010OtherHIGMARK PROVIDER NUMBER