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General NPI Number Information
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NPI Number | 1891094538
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Entity Type | Organization
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Legal Business Name | KNOL CHIROPRACTIC CLINIC INC.
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Dates
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Enumeration Date | 03/21/2011
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Last Update Date | 03/21/2011
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Provider Practice Location Address
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Address Line | 2450 VAN OMMEN DR SUITE C
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City | HOLLAND
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State | MI
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Zip | 49424-8085
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Country | US
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Telephone | 616-355-7870
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Fax |
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Provider Business Mailing Address
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Address Line | 2450 VAN OMMEN DR SUITE C
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City | HOLLAND
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State | MI
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Zip | 49424-8085
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Country | US
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Telephone | 616-355-7870
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JENNIFER S KNOL
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Credential | D.C.
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Telephone | 616-355-7870
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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 | 2301005240
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License Number State | MI
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