Provider Demographics
NPI:1477589109
Name:KNEWTSON FAMILY CHIROPRACTIC PA
Entity Type:Organization
Organization Name:KNEWTSON FAMILY CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:KNEWTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-470-8555
Mailing Address - Street 1:23505 SMITHTOWN RD
Mailing Address - Street 2:STE 100
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-4541
Mailing Address - Country:US
Mailing Address - Phone:952-470-8555
Mailing Address - Fax:952-401-8785
Practice Address - Street 1:23505 SMITHTOWN RD
Practice Address - Street 2:STE 100
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-4541
Practice Address - Country:US
Practice Address - Phone:952-470-8555
Practice Address - Fax:952-401-8785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty