Healthcare Provider Details

I. General information

NPI: 1265590608
Provider Name (Legal Business Name): ROGER G KNOWLES D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12792 W. ALAMEDA PKWY., SUITE E
LAKEWOOD CO
80228
US

IV. Provider business mailing address

220 SUNRISE AVE
MEDFORD OR
97504-6660
US

V. Phone/Fax

Practice location:
  • Phone: 303-988-8823
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number5909
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number2281
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: