Provider Demographics
NPI:1013131523
Name:KNOL, JENNIFER SUE (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SUE
Last Name:KNOL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2450 VAN OMMEN DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8085
Mailing Address - Country:US
Mailing Address - Phone:616-355-7870
Mailing Address - Fax:616-355-7872
Practice Address - Street 1:2450 VAN OMMEN DR
Practice Address - Street 2:SUITE C
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8085
Practice Address - Country:US
Practice Address - Phone:616-355-7870
Practice Address - Fax:616-355-7872
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2797070Medicaid
MI2797070Medicaid