Provider Demographics
NPI:1760476600
Name:KNIGHT, PHILIP L (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:L
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 1:420 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1667
Mailing Address - Country:US
Mailing Address - Phone:269-781-7000
Mailing Address - Fax:269-781-2522
Practice Address - Street 1:420 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1667
Practice Address - Country:US
Practice Address - Phone:269-781-7000
Practice Address - Fax:269-781-2522
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP56819OtherBLUE CARE NETWORK
MIP56819OtherBLUE CARE NETWORK