Healthcare Provider Details

I. General information

NPI: 1518966555
Provider Name (Legal Business Name): REX JAMES KNAUF M.S., D.C.,C.C.E.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

26 SCHOOL ST
CHILTON WI
53014-1346
US

IV. Provider business mailing address

26 SCHOOL ST
CHILTON WI
53014-1346
US

V. Phone/Fax

Practice location:
  • Phone: 920-849-9150
  • Fax: 920-849-7344
Mailing address:
  • Phone: 920-849-9150
  • Fax: 920-849-7344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2549-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: