MEDICARE: MR. KENNETH M 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	6343	GA

General Provider Information

NPI Number	:	1902978208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH M KNOX DC

Provider Business Mailing Address
First Line	:	7108 BRIXWORTH PLACE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30319
Country	:	US
Telephone Number	:	404-315-9749
Fax Number	:	404-315-9749

Provider Business Practice Location Address
First Line	:	7108 BRIXWORTH PLACE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30319
Country	:	US
Telephone Number	:	404-315-9749
Fax Number	:	404-315-9749

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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