MEDICARE: DR. DUSTIN SPENSER KNICKREHM 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	2571	AL

General Provider Information

NPI Number	:	1770062747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUSTIN SPENSER KNICKREHM DC

Provider Business Mailing Address
First Line	:	521 MONTGOMERY HWY STE 121
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35216-1876
Country	:	US
Telephone Number	:	205-734-0911
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 MONTGOMERY HWY STE 121
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35216-1876
Country	:	US
Telephone Number	:	205-734-0911
Fax Number	:

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

Provider Enumeration Date	:	08/10/2018
Last Update Date	:	10/08/2020

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