=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578830261
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KNUDSON CHIROPRACTIC P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2011
-----------------------------------------------------
Last Update Date | 11/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5008 NE 45TH TER
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64117-1944
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-452-4250
-----------------------------------------------------
Fax | 816-452-4250
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5008 NE 45TH TER
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64117-1944
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-452-4250
-----------------------------------------------------
Fax | 816-452-4250
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DON L KNUDSON
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 816-452-4250
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 006638
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------