Provider Demographics
NPI:1073606562
Name:STIFTER-KNOLL, MEGANNE G (DC)
Entity Type:Individual
Prefix:DR
First Name:MEGANNE
Middle Name:G
Last Name:STIFTER-KNOLL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 JUNIPER ST, PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:LESTER PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55354-0026
Mailing Address - Country:US
Mailing Address - Phone:320-395-9827
Mailing Address - Fax:320-395-9837
Practice Address - Street 1:32 JUNIPER ST
Practice Address - Street 2:LESTER PRAIRIE CHIROPRACTIC CLINIC
Practice Address - City:LESTER PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55354-0026
Practice Address - Country:US
Practice Address - Phone:320-395-9827
Practice Address - Fax:320-395-9837
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN287P4LEOtherBCBS GROUP NUMBER
MN288P4STOtherBCBS PROVIDER NUMBER
MN287P4LEOtherBCBS GROUP NUMBER
MNU98163Medicare UPIN