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General NPI Number Information
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NPI Number | 1275121014
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Entity Type | Individual
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Provider Name | ETHAN QUINN DC
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Gender | Male
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Dates
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Enumeration Date | 01/07/2021
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 3155 S ORANGE AVE
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City | ORLANDO
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State | FL
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Zip | 32806-6193
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Country | US
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Telephone | 407-289-1055
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Fax |
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Provider Business Mailing Address
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Address Line | 712 NICOLET AVE APT 35
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City | WINTER PARK
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State | FL
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Zip | 32789-4654
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Country | US
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Telephone | 717-314-2699
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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 | 13351
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License Number State | FL
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