Provider Demographics
NPI:1629165667
Name:KNIGHT, MARK ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:KNIGHT
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 1:5674 CAITO DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-1375
Mailing Address - Country:US
Mailing Address - Phone:317-441-1114
Mailing Address - Fax:317-541-1115
Practice Address - Street 1:5674 CAITO DR
Practice Address - Street 2:SUITE 110
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-1375
Practice Address - Country:US
Practice Address - Phone:317-441-1114
Practice Address - Fax:317-541-1115
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12650EMedicare UPIN
IN089330Medicare ID - Type Unspecified