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General NPI Number Information
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NPI Number | 1144775800
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Entity Type | Individual
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Provider Name | MITCHELL QUILL D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/23/2016
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Last Update Date | 04/05/2019
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Provider Practice Location Address
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Address Line | 550 E BOUGHTON RD STE 150
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City | BOLINGBROOK
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State | IL
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Zip | 60440
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Country | US
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Telephone | 620-739-1791
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Fax |
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Provider Business Mailing Address
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Address Line | 550 E BOUGHTON RD STE 150
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City | BOLINGBROOK
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State | IL
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Zip | 60440-2189
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Country | US
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Telephone | 224-301-3043
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038012954
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License Number State | IL
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