Provider Demographics
NPI:1154495539
Name:KNIGHT, ROGER HOWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:HOWARD
Last Name:KNIGHT
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 W. CHANNEL ISLANDS BLVD.
Mailing Address - Street 2:STE. 4
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041
Mailing Address - Country:US
Mailing Address - Phone:805-984-1500
Mailing Address - Fax:805-382-8043
Practice Address - Street 1:521 W CHANNEL ISLANDS BLVD
Practice Address - Street 2:STE. 4
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041-2132
Practice Address - Country:US
Practice Address - Phone:805-984-1500
Practice Address - Fax:805-382-8043
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC20257Medicare PIN