Provider Demographics
NPI:1053413864
Name:QUINT, JACOB RYAN (DC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:RYAN
Last Name:QUINT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2452 DEER RUN RD
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960-6031
Mailing Address - Country:US
Mailing Address - Phone:618-564-2850
Mailing Address - Fax:
Practice Address - Street 1:1665 OAK PARK BLVD.
Practice Address - Street 2:
Practice Address - City:CALVERT CITY
Practice Address - State:KY
Practice Address - Zip Code:42029
Practice Address - Country:US
Practice Address - Phone:270-909-2200
Practice Address - Fax:270-909-2201
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010700111N00000X
KY5129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor