Provider Demographics
NPI:1578830261
Name:KNUDSON CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:KNUDSON CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:L
Authorized Official - Last Name:KNUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-452-4250
Mailing Address - Street 1:5008 NE 45TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64117-1944
Mailing Address - Country:US
Mailing Address - Phone:816-452-4250
Mailing Address - Fax:816-452-4250
Practice Address - Street 1:5008 NE 45TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64117-1944
Practice Address - Country:US
Practice Address - Phone:816-452-4250
Practice Address - Fax:816-452-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006638111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU71300Medicare UPIN