Provider Demographics
NPI:1003055153
Name:KNOX INTEGRATED HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:KNOX INTEGRATED HEALTH SERVICES, LLC
Other - Org Name:WATER TOWER PLACE CHIROPRACTIC, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-401-0958
Mailing Address - Street 1:PO BOX 9307
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60598-9307
Mailing Address - Country:US
Mailing Address - Phone:630-401-0958
Mailing Address - Fax:312-654-2175
Practice Address - Street 1:845 N MICHIGAN AVE
Practice Address - Street 2:983W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2252
Practice Address - Country:US
Practice Address - Phone:312-654-5486
Practice Address - Fax:312-654-2175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010179111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty