Individual
LESLIE R QUIRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
2412 E WASHINGTON ST, SUITE 9A, BLOOMINGTON, IL 61704-4497
(309) 662-6462
(309) 663-8812
Mailing address
2412 E WASHINGTON ST, SUITE 9A, BLOOMINGTON, IL 61704-4497
(309) 662-6462
(309) 663-8812
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5732002
BCBS PPO PROVIDER #
IL
Enumeration date
02/28/2006
Last updated
12/04/2007
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