Individual provider Active NPI

Marisa Dawn Quevedo, DC

  • Chiropractor
  • Rowlett, TX
National Provider Identifier
1114736923
Registry record updated Jan 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
16278 Issued in TX
Practice address
8405 Lakeview Pkwy Ste 202
Rowlett, TX 75088-4559
Phone
(972) 412-1150
Fax
(972) 412-1160
NPI assigned
Jan 6, 2025
Last updated
Jan 6, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 16278 TX Primary

Addresses

Primary practice location

8405 Lakeview Pkwy Ste 202
Rowlett, TX 75088-4559

Mailing address

8405 Lakeview Pkwy Ste 202
Rowlett, TX 75088-4559
Phone (972) 412-1150

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250131002992 TX Practitioner - Chiropractic 5395274518

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16278TXMDChiropractor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736121600000",
    "number": "1114736923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8405 LAKEVIEW PKWY STE 202",
            "city": "ROWLETT",
            "state": "TX",
            "postal_code": "750884559",
            "telephone_number": "972-412-1150",
            "fax_number": "972-412-1160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8405 LAKEVIEW PKWY STE 202",
            "city": "ROWLETT",
            "state": "TX",
            "postal_code": "750884559",
            "telephone_number": "972-412-1150",
            "fax_number": "972-412-1160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUEVEDO",
        "first_name": "MARISA",
        "middle_name": "DAWN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-06",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "16278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rowlett, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.