Provider Demographics
NPI:1669668711
Name:KNOBBE, GREGORY BRENT (DC,)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:BRENT
Last Name:KNOBBE
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 1:10101 SLATER AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4733
Mailing Address - Country:US
Mailing Address - Phone:714-962-9767
Mailing Address - Fax:714-218-6924
Practice Address - Street 1:10101 SLATER AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4733
Practice Address - Country:US
Practice Address - Phone:714-962-9767
Practice Address - Fax:714-218-6924
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-22
Last Update Date:2007-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23032111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician