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General NPI Number Information
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NPI Number | 1588720684
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Entity Type | Individual
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Provider Name | TY CHARLES QUICKENDEN D.C.
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Gender | Male
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Dates
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Enumeration Date | 12/31/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2632 FOOTHILL BLVD SUITE 107
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-4756
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Country | US
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Telephone | 307-362-7900
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Fax | 307-362-8230
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Provider Business Mailing Address
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Address Line | 525 EMERALD ST
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-6740
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Country | US
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Telephone | 307-362-0943
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Fax | 307-362-8230
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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 | 589
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License Number State | WY
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