Provider Demographics
NPI:1770062747
Name:KNICKREHM, DUSTIN SPENSER (DC)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:SPENSER
Last Name:KNICKREHM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 MONTGOMERY HWY STE 121
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1876
Mailing Address - Country:US
Mailing Address - Phone:205-734-0911
Mailing Address - Fax:
Practice Address - Street 1:521 MONTGOMERY HWY STE 121
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-1876
Practice Address - Country:US
Practice Address - Phone:205-734-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor