Provider Demographics
NPI:1659812386
Name:KNOLL, RILEY P (DC)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:P
Last Name:KNOLL
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 1:1715 BURNT BOAT DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0853
Mailing Address - Country:US
Mailing Address - Phone:701-221-2600
Mailing Address - Fax:701-221-9082
Practice Address - Street 1:1715 BURNT BOAT DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0853
Practice Address - Country:US
Practice Address - Phone:701-221-2600
Practice Address - Fax:701-221-9082
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor