MEDICARE: AUGUSTA WAYNESBORO CHIROPRACTIC LLC

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	0104000301	VA

General Provider Information

NPI Number	:	1154507424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUGUSTA WAYNESBORO CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	2016 GOOSE CREEK ROAD
Second Line	:	SUITE 104
City	:	WAYNESBORO
State	:	VA
Zip	:	22980-8501
Country	:	US
Telephone Number	:	540-943-1434
Fax Number	:	540-943-5292

Provider Business Practice Location Address
First Line	:	2016 GOOSE CREEK ROAD
Second Line	:	SUITE 104
City	:	WAYNESBORO
State	:	VA
Zip	:	22980-8501
Country	:	US
Telephone Number	:	540-943-1434
Fax Number	:	540-943-5292

Authorized Official
Title or Position	:	OWNER CHIROPRACTOR
Name	:	DR. WILLIAM JOHN KNIZNER
Credential	:	DC
Telephone Number	:	540-943-1434

Provider Enumeration Date	:	01/16/2008
Last Update Date	:	02/06/2008

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