Provider Demographics
NPI:1962881839
Name:KNAUP, NICHOLAS (DC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:KNAUP
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 1:1400 FORUM BLVD STE 7A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-1997
Mailing Address - Country:US
Mailing Address - Phone:573-694-9212
Mailing Address - Fax:
Practice Address - Street 1:18997 HIGHWAY C
Practice Address - Street 2:
Practice Address - City:BARNETT
Practice Address - State:MO
Practice Address - Zip Code:65011
Practice Address - Country:US
Practice Address - Phone:573-694-9212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015013971111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor