Provider Demographics
NPI:1235423401
Name:KNOX, JACK H (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:H
Last Name:KNOX
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 1:720 CAPITOLA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2784
Mailing Address - Country:US
Mailing Address - Phone:831-464-1501
Mailing Address - Fax:831-464-1927
Practice Address - Street 1:720 CAPITOLA AVE STE A
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2784
Practice Address - Country:US
Practice Address - Phone:831-464-1501
Practice Address - Fax:831-464-1927
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor