Provider Demographics
NPI:1265014294
Name:KNODERER CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:KNODERER CHIROPRACTIC CENTER LLC
Other - Org Name:KETTERING CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:KNODERER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-875-7257
Mailing Address - Street 1:3817 WILMINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5043
Mailing Address - Country:US
Mailing Address - Phone:937-875-7257
Mailing Address - Fax:
Practice Address - Street 1:3817 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5043
Practice Address - Country:US
Practice Address - Phone:937-298-9039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty