Provider Demographics
NPI:1629266150
Name:FAMILY CHIROPRACTIC OF KNOX, INC.
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC OF KNOX, INC.
Other - Org Name:JEFFERY A. GREEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-797-2863
Mailing Address - Street 1:108 ROSSMAN AVE
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:PA
Mailing Address - Zip Code:16232-1844
Mailing Address - Country:US
Mailing Address - Phone:814-797-2863
Mailing Address - Fax:814-797-2863
Practice Address - Street 1:108 ROSSMAN AVE
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:PA
Practice Address - Zip Code:16232-1844
Practice Address - Country:US
Practice Address - Phone:814-797-2863
Practice Address - Fax:814-797-2863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA066888Medicare PIN