Provider Demographics
NPI:1639316557
Name:LYNN M KNUTH, LLC
Entity Type:Organization
Organization Name:LYNN M KNUTH, LLC
Other - Org Name:RED MOUNTAIN FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KNUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-924-7632
Mailing Address - Street 1:PO BOX 21658
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85277-1658
Mailing Address - Country:US
Mailing Address - Phone:480-924-7632
Mailing Address - Fax:480-924-7622
Practice Address - Street 1:2044 N RECKER RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2744
Practice Address - Country:US
Practice Address - Phone:480-924-7632
Practice Address - Fax:480-924-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ108102Medicare UPIN
AZ108101Medicare PIN