=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083680698
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARCEL QUINONES DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7401 PRESTON HWY
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40219-2755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-962-8700
-----------------------------------------------------
Fax | 502-962-8714
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14601 WOODSTREAM PL
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40245-5165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-244-4646
-----------------------------------------------------
Fax | 502-244-4402
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4145
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------