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Individual

DR. BARRY A QUAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DC PS

Contact information

Practice address
25012 104TH AVE SE, SUITE E, KENT, WA 98030-2821
(253) 854-1233
(253) 854-1297
Mailing address
25012 - 104TH AVE SE, SUITE E, KENT, WA 98030-2821
(253) 854-1233
(253) 854-1297

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH00001274
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0003977
L&I
WA
01
193043300
US DEPT OF LABOR FEDERAL
05
2023703
WA
01
459124001
GROUP HEALTH INS
WA
01
601798401
WASHINGTON STATE UBI
01
911088995
TAX ID
01
QU0183
GROUP #
01
QU5942
REGENCE INSURANCE
Enumeration date
06/20/2006
Last updated
02/08/2011
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