Provider Demographics
NPI:1497337265
Name:KNIGHT, OLIVIA R (DC)
Entity Type:Individual
Prefix:MISS
First Name:OLIVIA
Middle Name:R
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 N PAW PAW ST
Mailing Address - Street 2:
Mailing Address - City:COLOMA
Mailing Address - State:MI
Mailing Address - Zip Code:49038-9567
Mailing Address - Country:US
Mailing Address - Phone:269-468-5775
Mailing Address - Fax:
Practice Address - Street 1:429 N PAW PAW ST
Practice Address - Street 2:
Practice Address - City:COLOMA
Practice Address - State:MI
Practice Address - Zip Code:49038-9567
Practice Address - Country:US
Practice Address - Phone:269-468-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301011067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor