Provider Demographics
NPI:1851485270
Name:KNISKERN, R. B (PHD, LAC, OMD)
Entity Type:Individual
Prefix:DR
First Name:R.
Middle Name:B
Last Name:KNISKERN
Suffix:
Gender:M
Credentials:PHD, LAC, OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070
Mailing Address - Country:US
Mailing Address - Phone:650-595-5666
Mailing Address - Fax:650-595-5667
Practice Address - Street 1:1328 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-5005
Practice Address - Country:US
Practice Address - Phone:650-595-5666
Practice Address - Fax:650-595-5667
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4728171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist