Provider Demographics
NPI:1558451518
Name:KNOBLOCH, TADD LEE (DC,)
Entity Type:Individual
Prefix:DR
First Name:TADD
Middle Name:LEE
Last Name:KNOBLOCH
Suffix:
Gender:M
Credentials:DC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:HARTLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51346-1435
Mailing Address - Country:US
Mailing Address - Phone:712-728-2364
Mailing Address - Fax:712-728-3409
Practice Address - Street 1:110 S 1ST AVE E
Practice Address - Street 2:
Practice Address - City:HARTLEY
Practice Address - State:IA
Practice Address - Zip Code:51346-1435
Practice Address - Country:US
Practice Address - Phone:712-728-2364
Practice Address - Fax:712-728-3409
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06014111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1151852Medicaid
IA1151852Medicaid
IAU65609Medicare UPIN