MEDICARE: TY C. QUICKENDEN CHIROPRACTIC, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	589	WY

General Provider Information

NPI Number	:	1578706941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TY C. QUICKENDEN CHIROPRACTIC, P.C.

Provider Business Mailing Address
First Line	:	2632 FOOTHILL BLVD
Second Line	:	SUITE 107
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4756
Country	:	US
Telephone Number	:	307-362-7900
Fax Number	:	307-362-8230

Provider Business Practice Location Address
First Line	:	2632 FOOTHILL BLVD
Second Line	:	SUITE 107
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4756
Country	:	US
Telephone Number	:	307-362-7900
Fax Number	:	307-362-8230

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TY C QUICKENDEN
Credential	:	D.C.
Telephone Number	:	307-362-7900

Provider Enumeration Date	:	04/14/2009
Last Update Date	:	04/14/2009

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