Provider Demographics
NPI:1316411150
Name:KNIPPER, JODY (LMT)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:KNIPPER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N MICHIGAN AVE STE 2100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3773
Mailing Address - Country:US
Mailing Address - Phone:312-276-1212
Mailing Address - Fax:312-276-1213
Practice Address - Street 1:500 N MICHIGAN AVE STE 2100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3773
Practice Address - Country:US
Practice Address - Phone:312-276-1212
Practice Address - Fax:312-276-1213
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227002213225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14393153OtherCAQH