Healthcare Provider Details

I. General information

NPI: 1740324821
Provider Name (Legal Business Name): KNOWLES CHIROPRACTIC OFFICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12792 W ALAMEDA PKWY STE E
LAKEWOOD CO
80228
US

IV. Provider business mailing address

950 N PHOENIX RD STE 103
MEDFORD OR
97504-9444
US

V. Phone/Fax

Practice location:
  • Phone: 303-988-8823
  • Fax:
Mailing address:
  • Phone: 303-987-2539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number2281
License Number StateCO

VIII. Authorized Official

Name: ROGER G KNOWLES
Title or Position: OFFICER
Credential: D.C.
Phone: 303-987-2539