Provider Demographics
NPI:1144472325
Name:QUINN, CANDACE JO (L AC)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:JO
Last Name:QUINN
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4786 HORNBY RD
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-9448
Mailing Address - Country:US
Mailing Address - Phone:607-377-4216
Mailing Address - Fax:
Practice Address - Street 1:1 E PULTENEY ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2268
Practice Address - Country:US
Practice Address - Phone:607-377-4216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3917171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist