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General NPI Number Information
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NPI Number | 1912020033
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Entity Type | Organization
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Legal Business Name | FOUNTAIN OF LIFE FAMILY CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 8335 N CONGRESS AVE
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City | KANSAS CITY
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State | MO
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Zip | 64152-2041
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Country | US
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Telephone | 816-741-4711
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Fax | 816-741-0119
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Provider Business Mailing Address
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Address Line | 8335 N CONGRESS AVE
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City | KANSAS CITY
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State | MO
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Zip | 64152-2041
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Country | US
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Telephone | 816-741-4711
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Fax | 816-741-0119
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH MICHAEL KNUDSON
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Credential | D.C.
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Telephone | 816-741-4711
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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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