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General NPI Number Information
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NPI Number | 1467428409
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Entity Type | Individual
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Provider Name | LESLIE R QUIRAM DC
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Gender | Male
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 2412 E WASHINGTON ST SUITE 9A
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City | BLOOMINGTON
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State | IL
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Zip | 61704-4497
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Country | US
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Telephone | 309-662-6462
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Fax | 309-663-8812
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Provider Business Mailing Address
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Address Line | 2412 E WASHINGTON ST SUITE 9A
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City | BLOOMINGTON
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State | IL
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Zip | 61704-4497
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Country | US
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Telephone | 309-662-6462
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Fax | 309-663-8812
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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 |
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License Number State | IL
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