MEDICARE: KNOL CHIROPRACTIC CLINIC INC.

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	2301005240	MI

General Provider Information

NPI Number	:	1891094538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNOL CHIROPRACTIC CLINIC INC.

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	:

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	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JENNIFER S KNOL
Credential	:	D.C.
Telephone Number	:	616-355-7870

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	03/21/2011

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