MEDICARE: DALE WARREN KNOBBS 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	3291	CO

General Provider Information

NPI Number	:	1770763898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALE WARREN KNOBBS DC

Provider Business Mailing Address
First Line	:	4305 BEVERLY ST
Second Line	:	SUITE B
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-5906
Country	:	US
Telephone Number	:	719-528-5656
Fax Number	:	719-528-6210

Provider Business Practice Location Address
First Line	:	4305 BEVERLY ST
Second Line	:	SUITE B
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-5906
Country	:	US
Telephone Number	:	719-528-5656
Fax Number	:	719-528-6210

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

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	07/13/2010

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