Provider Demographics
NPI:1417440819
Name:KNAPP FAMILY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:KNAPP FAMILY CHIROPRACTIC, PLLC
Other - Org Name:KNAPP FAMILY CHIROPRACTIC, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNOR
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-551-0680
Mailing Address - Street 1:6807 CASCADE RD SE STE D
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8722
Mailing Address - Country:US
Mailing Address - Phone:616-551-0680
Mailing Address - Fax:
Practice Address - Street 1:6807 CASCADE RD SE STE D
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8722
Practice Address - Country:US
Practice Address - Phone:616-551-0680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty