MEDICARE: DR. PENELOPE KNOX DC

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	CH12018	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	208939201	OTHER	FL	CASH

General Provider Information

NPI Number	:	1316482730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PENELOPE KNOX DC

Provider Business Mailing Address
First Line	:	25 N MARKET ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-2802
Country	:	US
Telephone Number	:	404-790-8426
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 N MARKET ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-2802
Country	:	US
Telephone Number	:	404-790-8426
Fax Number	:

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

Provider Enumeration Date	:	12/20/2016
Last Update Date	:	03/17/2018

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