Provider Demographics
NPI:1295467967
Name:KNUTSON, BRENT (DC)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:KNUTSON
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 1:3546 SAINT JOHNS BLUFF RD S UNIT 204
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2716
Mailing Address - Country:US
Mailing Address - Phone:904-996-2243
Mailing Address - Fax:
Practice Address - Street 1:3546 SAINT JOHNS BLUFF RD S UNIT 204
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2716
Practice Address - Country:US
Practice Address - Phone:904-996-2243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14133111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor