Healthcare Provider Details

I. General information

NPI: 1124169388
Provider Name (Legal Business Name): THOMAS E. MCKNIGHT JR DO MPH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 INDEPENDENCE CIR SUITE 5
CHICO CA
95973-4962
US

IV. Provider business mailing address

236 W EAST AVE PMB 104
CHICO CA
95926-7235
US

V. Phone/Fax

Practice location:
  • Phone: 530-896-0260
  • Fax: 530-896-0287
Mailing address:
  • Phone: 530-896-0260
  • Fax: 530-896-0287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A4876
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number20A4876
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number20A4876
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number20A4876
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number20A4876
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number20A4876
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20A4876
License Number StateCA

VIII. Authorized Official

Name: DR. THOMAS E MCKNIGHT JR.
Title or Position: PRESIDENT
Credential: DO MPH
Phone: 530-896-0260