MEDICARE: KNOBBS 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	3291	CO

General Provider Information

NPI Number	:	1245391663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNOBBS CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	4305 BEVERLY STREET
Second Line	:	SUITE B
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-6623
Country	:	US
Telephone Number	:	719-528-5656
Fax Number	:	719-528-6210

Provider Business Practice Location Address
First Line	:	4305 BEVERLY STREET
Second Line	:	SUITE B
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-6623
Country	:	US
Telephone Number	:	719-528-5656
Fax Number	:	719-528-6210

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. JENAL MARIE BARKAS
Credential	:	OFFICE MANAGER
Telephone Number	:	719-528-5656

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	10/18/2007

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