Provider Demographics
NPI:1285810267
Name:KNUTSON, JOSHUA A (DC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:A
Last Name:KNUTSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12395 SW 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8508
Mailing Address - Country:US
Mailing Address - Phone:503-431-2388
Mailing Address - Fax:503-431-6733
Practice Address - Street 1:12395 SW 68TH AVE
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8508
Practice Address - Country:US
Practice Address - Phone:503-431-2388
Practice Address - Fax:503-431-6733
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor