MEDICARE: KNIGHTLY CHIROPRACTIC, INC.

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	DC27792	CA

General Provider Information

NPI Number	:	1952585200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNIGHTLY CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	3627 30TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-3508
Country	:	US
Telephone Number	:	619-295-2141
Fax Number	:	619-295-2142

Provider Business Practice Location Address
First Line	:	3627 30TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-3508
Country	:	US
Telephone Number	:	619-295-2141
Fax Number	:	619-295-2142

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS VINCENT KNIGHTLY
Credential	:	D.C.
Telephone Number	:	619-295-2141

Provider Enumeration Date	:	12/21/2007
Last Update Date	:	12/21/2007

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Directions to “KNIGHTLY CHIROPRACTIC, INC. ” Practice Location

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