Provider Demographics
NPI:1396870507
Name:KNUTSON CHIROPRACTIC CLINIC PC
Entity type:Organization
Organization Name:KNUTSON CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KNUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-266-1838
Mailing Address - Street 1:622 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-2949
Mailing Address - Country:US
Mailing Address - Phone:319-266-1838
Mailing Address - Fax:319-268-1460
Practice Address - Street 1:622 MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2949
Practice Address - Country:US
Practice Address - Phone:319-266-1838
Practice Address - Fax:319-268-1460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0277566Medicaid
T00774Medicare UPIN
IA0277566Medicaid
IAI5769Medicare PIN