Provider Demographics
NPI:1346247012
Name:KNIGHT, CHARLES DUANE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DUANE
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15550 ROCKFIELD BLVD
Mailing Address - Street 2:B220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2720
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:79440 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 108
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-7241
Practice Address - Country:US
Practice Address - Phone:760-564-4052
Practice Address - Fax:760-564-3569
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADC22742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-0797641OtherTAX IDENTIFICATION NUMBER
CAU44522-CMedicare UPIN
CADC0227420Medicare ID - Type Unspecified
CADC0227420Medicare PIN