Provider Demographics
NPI:1942375969
Name:KNOWLES III, JOHN RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD
Last Name:KNOWLES III
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 1:7153 W EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8620
Mailing Address - Country:US
Mailing Address - Phone:208-376-1866
Mailing Address - Fax:208-377-5265
Practice Address - Street 1:7153 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8620
Practice Address - Country:US
Practice Address - Phone:208-376-1866
Practice Address - Fax:208-377-5265
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-591111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010020078OtherREGENCE BLUE SHIELD
IDC5915OtherBLUE CROSS OF IDAHO
IDC5915OtherBLUE CROSS OF IDAHO
ID000010020078OtherREGENCE BLUE SHIELD