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General NPI Number Information
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NPI Number | 1962879775
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Entity Type | Organization
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Legal Business Name | KNIPP CHIROPRACTIC INC
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Dates
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Enumeration Date | 08/27/2015
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Last Update Date | 08/27/2015
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Provider Practice Location Address
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Address Line | 500 N CAROL MALONE BLVD
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City | GRAYSON
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State | KY
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Zip | 41143-1122
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Country | US
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Telephone | 304-743-8281
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5
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City | GRAYSON
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State | KY
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Zip | 41143-0005
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Country | US
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Telephone | 304-743-8281
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Fax |
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Authorized Official
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Title or Position | CREDENTIALIST/CORPORATION SECRETARY
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Name | MRS. LAURA L MOUL
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Credential |
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Telephone | 304-743-8281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 5391
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License Number State | KY
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