Provider Demographics
NPI:1447519061
Name:GLENN V. QUINTANA D.C., P.A.
Entity type:Organization
Organization Name:GLENN V. QUINTANA D.C., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:VICENTE
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-670-9313
Mailing Address - Street 1:9406 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2934
Mailing Address - Country:US
Mailing Address - Phone:305-670-9313
Mailing Address - Fax:305-670-9313
Practice Address - Street 1:9406 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2934
Practice Address - Country:US
Practice Address - Phone:305-670-9313
Practice Address - Fax:305-670-9313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU25752Medicare UPIN