Healthcare Provider Details

I. General information

NPI: 1508951484
Provider Name (Legal Business Name): HEALTHQUEST OF AVON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33560 DETROIT RD
AVON OH
44011-2030
US

IV. Provider business mailing address

33560 DETROIT RD
AVON OH
44011-2030
US

V. Phone/Fax

Practice location:
  • Phone: 440-937-4222
  • Fax: 440-967-8715
Mailing address:
  • Phone: 440-937-4222
  • Fax: 440-967-8715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3492
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3350
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT 06257
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8647
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2074
License Number StateOH

VIII. Authorized Official

Name: MRS. KRISTY ANN CAIN
Title or Position: PRESIDENT
Credential:
Phone: 440-937-4222