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General NPI Number Information
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NPI Number | 1801616503
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Entity Type | Organization
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Legal Business Name | QUEEN CREEK MEDICAL, PLLC
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 21258 E RITTENHOUSE RD STE 110
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-9341
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Country | US
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Telephone | 480-867-8782
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Fax |
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Provider Business Mailing Address
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Address Line | 21258 E RITTENHOUSE RD STE 110
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-9341
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Country | US
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Telephone | 480-867-8782
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. QUENTIN SMITH
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Credential | DC
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Telephone | 480-867-8782
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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 |
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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