Healthcare Provider Details

I. General information

NPI: 1336435940
Provider Name (Legal Business Name): QI NEUROLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 HANOVER ST SUITE 302
MANCHESTER NH
03104-5401
US

IV. Provider business mailing address

21 BLOSSOM ST
PORTSMOUTH NH
03801-4519
US

V. Phone/Fax

Practice location:
  • Phone: 603-218-1175
  • Fax: 603-218-1174
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number117
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number2693
License Number StateMA

VIII. Authorized Official

Name: DR. KENT A LOGAN
Title or Position: OWNER/MANAGER
Credential: MD
Phone: 603-591-2624