Provider Demographics
NPI:1548476674
Name:KNOWLES CHIROPRACTIC LLC
Entity type:Organization
Organization Name:KNOWLES CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:KNOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-459-8475
Mailing Address - Street 1:1414 N TAYLOR DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-1988
Mailing Address - Country:US
Mailing Address - Phone:920-459-8475
Mailing Address - Fax:920-694-0437
Practice Address - Street 1:1414 N TAYLOR DR
Practice Address - Street 2:SUITE 105
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-1988
Practice Address - Country:US
Practice Address - Phone:920-459-8475
Practice Address - Fax:920-694-0437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty