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General NPI Number Information
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NPI Number | 1023774585
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Entity Type | Organization
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Legal Business Name | DE-KNOT, LLC
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 03/03/2022
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Provider Practice Location Address
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Address Line | 15620 N TATUM BLVD STE 130
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City | PHOENIX
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State | AZ
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Zip | 85032-4450
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Country | US
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Telephone | 26-612-2009
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Fax |
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Provider Business Mailing Address
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Address Line | 15620 N TATUM BLVD STE 130
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City | PHOENIX
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State | AZ
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Zip | 85032-4450
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FRANCHISEE
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Name | TRACEY EPEL
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Credential |
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Telephone | 719-217-0895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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