Provider Demographics
NPI:1962694703
Name:HUSTON, QUENTIN MAX (DC)
Entity type:Individual
Prefix:DR
First Name:QUENTIN
Middle Name:MAX
Last Name:HUSTON
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 1:1147 US HIGHWAY 80 W STE B
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-2199
Mailing Address - Country:US
Mailing Address - Phone:912-748-1506
Mailing Address - Fax:912-748-1507
Practice Address - Street 1:1147 US HIGHWAY 80 W STE B
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-2199
Practice Address - Country:US
Practice Address - Phone:912-748-1506
Practice Address - Fax:912-748-1507
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06953111N00000X
GACHIRO11064111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor