=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790053262
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KNAPP CHIROPRACTIC AND WELLNESS CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2011
-----------------------------------------------------
Last Update Date | 04/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17800 W BLUEMOUND RD STE P
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53045-2924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-892-6562
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17800 W BLUEMOUND RD STE P
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53045-2924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-892-6562
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. NICOLE KNAPP
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 773-892-6562
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------