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General NPI Number Information
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NPI Number | 1861670317
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Entity Type | Organization
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Legal Business Name | STATE LINE CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 02/07/2008
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 103 E 4TH ST
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City | PINEVILLE
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State | MO
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Zip | 64856
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Country | US
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Telephone | 417-223-4736
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Fax | 417-223-4405
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Provider Business Mailing Address
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Address Line | PO BOX 672
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City | PINEVILLE
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State | MO
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Zip | 64856-0672
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Country | US
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Telephone | 417-226-4736
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Fax | 417-226-4405
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Authorized Official
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Title or Position | OWNER
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Name | ZACHARY A KNOX
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Credential |
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Telephone | 417-223-4736
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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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