Healthcare Provider Details

I. General information

NPI: 1245391663
Provider Name (Legal Business Name): KNOBBS CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 BEVERLY STREET SUITE B
COLORADO SPRINGS CO
80918-6623
US

IV. Provider business mailing address

4305 BEVERLY STREET SUITE B
COLORADO SPRINGS CO
80918-6623
US

V. Phone/Fax

Practice location:
  • Phone: 719-528-5656
  • Fax: 719-528-6210
Mailing address:
  • Phone: 719-528-5656
  • Fax: 719-528-6210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3291
License Number StateCO

VIII. Authorized Official

Name: MS. JENAL MARIE BARKAS
Title or Position: OFFICE MANAGER
Credential: OFFICE MANAGER
Phone: 719-528-5656