MEDICARE: JUSTIN KNIGHT 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	5500	OR

General Provider Information

NPI Number	:	1417382946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN KNIGHT D.C.

Provider Business Mailing Address
First Line	:	3736 NE CLEVELAND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-1001
Country	:	US
Telephone Number	:	971-373-5078
Fax Number	:

Provider Business Practice Location Address
First Line	:	2035 SE BELMONT ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-2812
Country	:	US
Telephone Number	:	503-502-3124
Fax Number	:

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

Provider Enumeration Date	:	09/03/2013
Last Update Date	:	11/30/2016

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