Healthcare Provider Details
I. General information
NPI: 1053943795
Provider Name (Legal Business Name): HEALTHQUEST CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/11/2020
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:
III. Provider practice location address
178 E 4TH ST
RUSSELLVILLE KY
42276-1820
US
IV. Provider business mailing address
PO BOX 156
ROCKFIELD KY
42274-0156
US
V. Phone/Fax
- Phone: 270-726-3164
- Fax: 270-726-1520
- Phone: 270-726-3164
- Fax: 270-726-1520
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 111N00000X |
| Taxonomy | Chiropractor |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
KEITH
A
JONES
Title or Position: OWNER/MANAGER
Credential: DC
Phone: 270-726-3164