Healthcare Provider Details

I. General information

NPI: 1902721574
Provider Name (Legal Business Name): MR. JONATHAN SCOTT QUINLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 N BRANDON LN
SALEM IN
47167-6948
US

IV. Provider business mailing address

574 N BRANDON LN
SALEM IN
47167-6948
US

V. Phone/Fax

Practice location:
  • Phone: 812-620-7208
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: