MEDICARE: DR. DUSTIN KNIFFIN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4723	OH
2	111N00000X	Chiropractor	3611	MA

General Provider Information

NPI Number	:	1265961833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUSTIN KNIFFIN D.C.

Provider Business Mailing Address
First Line	:	388 LAKEWOOD RD
Second Line	:
City	:	MADISON
State	:	ME
Zip	:	04950-3015
Country	:	US
Telephone Number	:	207-619-4450
Fax Number	:

Provider Business Practice Location Address
First Line	:	388 LAKEWOOD RD
Second Line	:
City	:	MADISON
State	:	ME
Zip	:	04950-3015
Country	:	US
Telephone Number	:	207-619-4450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2017
Last Update Date	:	06/22/2020

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