Provider Demographics
NPI:1417943879
Name:KNAFLA, KATHRYN MARIE (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:MARIE
Last Name:KNAFLA
Suffix:
Gender:F
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S RUM RIVER DR STE 102
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-2239
Mailing Address - Country:US
Mailing Address - Phone:763-389-5803
Mailing Address - Fax:763-389-0063
Practice Address - Street 1:900 S RUM RIVER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-2245
Practice Address - Country:US
Practice Address - Phone:763-389-5803
Practice Address - Fax:763-389-0063
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3105111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
350045207OtherPALMETTO GBA RAILROAD
MN4C215-KNOtherBLUE CROSS BLUE SHIELD OF MN GRP
MN4C216-KNOtherBLUE CROSS/BLUE SHIELD OF MN
MN991528100Medicaid
MN44-40199OtherMEDICA
MNCC0463OtherCC/LANDMARK
MN44-40199OtherMEDICA
MNU44222Medicare UPIN