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General NPI Number Information
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NPI Number | 1831325190
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Entity Type | Organization
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Legal Business Name | Q-C PAIN AND WELLNESS CENTER
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Dates
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Enumeration Date | 06/01/2009
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Last Update Date | 12/09/2010
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Provider Practice Location Address
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Address Line | 3724 46TH AVE
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City | ROCK ISLAND
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State | IL
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Zip | 61201-7047
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Country | US
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Telephone | 309-786-2071
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Fax | 309-558-1832
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Provider Business Mailing Address
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Address Line | 3724 46TH AVE
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City | ROCK ISLAND
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State | IL
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Zip | 61201-7047
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Country | US
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Telephone | 309-786-2071
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Fax | 309-558-1832
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. PAUL QUANG NGUYEN
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Credential | D.C
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Telephone | 309-786-2071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 038011360
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License Number State | IL
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