Provider Demographics
NPI:1982180212
Name:KNETTER, DANIELLE KAY (DC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:KAY
Last Name:KNETTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 GOLF RD STE 1
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6033
Mailing Address - Country:US
Mailing Address - Phone:715-563-5259
Mailing Address - Fax:
Practice Address - Street 1:2522 GOLF RD STE 1
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6033
Practice Address - Country:US
Practice Address - Phone:715-563-5259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5431-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3140OtherCHIROPRACTIC PHYSICIAN LICENSURE