Provider Demographics
NPI:1982964763
Name:QC WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:QC WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-797-4203
Mailing Address - Street 1:1535 47TH AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-7088
Mailing Address - Country:US
Mailing Address - Phone:309-797-4203
Mailing Address - Fax:309-797-4205
Practice Address - Street 1:1535 47TH AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7088
Practice Address - Country:US
Practice Address - Phone:309-797-4203
Practice Address - Fax:309-797-4205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty