Provider Demographics
NPI:1083138036
Name:KNUTSON CHIROPRACTIC PA
Entity Type:Organization
Organization Name:KNUTSON CHIROPRACTIC PA
Other - Org Name:KNUTSON CHIROPRACTIC PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KNUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-280-6933
Mailing Address - Street 1:PO BOX 434
Mailing Address - Street 2:
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-0434
Mailing Address - Country:US
Mailing Address - Phone:218-280-6933
Mailing Address - Fax:
Practice Address - Street 1:12631 FREMONT AVE STE 5
Practice Address - Street 2:
Practice Address - City:ZIMMERMAN
Practice Address - State:MN
Practice Address - Zip Code:55398-7100
Practice Address - Country:US
Practice Address - Phone:218-280-6933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty