Provider Demographics
NPI:1336633403
Name:KNOX, WILLIAM WALLACE II (LAC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WALLACE
Last Name:KNOX
Suffix:II
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4217
Mailing Address - Country:US
Mailing Address - Phone:412-849-9207
Mailing Address - Fax:
Practice Address - Street 1:686 N 9TH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5458
Practice Address - Country:US
Practice Address - Phone:412-849-9207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACU-313171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist