MEDICARE: DR. MARK A KNOLL DC

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	841	NE

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	:	1639128945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A KNOLL DC

Provider Business Mailing Address
First Line	:	11322 Q ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68137-3679
Country	:	US
Telephone Number	:	402-339-9510
Fax Number	:	402-592-0316

Provider Business Practice Location Address
First Line	:	11322 Q ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68137-3679
Country	:	US
Telephone Number	:	402-339-9510
Fax Number	:	402-592-0316

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

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	10/12/2007

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Directions to “ DR. MARK A KNOLL DC” Practice Location

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