Provider Demographics
NPI:1215995105
Name:KNUTSEN, CHAD M (DPM)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:M
Last Name:KNUTSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S SHIELDS ST STE F
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1833
Mailing Address - Country:US
Mailing Address - Phone:970-493-4660
Mailing Address - Fax:970-493-6710
Practice Address - Street 1:2001 S SHIELDS ST STE F
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1833
Practice Address - Country:US
Practice Address - Phone:970-493-4660
Practice Address - Fax:970-493-6710
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD0000508213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01005081Medicaid
COP00063361OtherRAILROAD MEDICARE
CO01005081Medicaid
CO522508Medicare ID - Type Unspecified