MEDICARE: DR. JENNIFER SUE KNOL D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301005340	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013131523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER SUE KNOL D.C.

Provider Business Mailing Address
First Line	:	2450 VAN OMMEN DR
Second Line	:	SUITE C
City	:	HOLLAND
State	:	MI
Zip	:	49424-8085
Country	:	US
Telephone Number	:	616-355-7870
Fax Number	:	616-355-7872

Provider Business Practice Location Address
First Line	:	2450 VAN OMMEN DR
Second Line	:	SUITE C
City	:	HOLLAND
State	:	MI
Zip	:	49424-8085
Country	:	US
Telephone Number	:	616-355-7870
Fax Number	:	616-355-7872

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	03/08/2011

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