Provider Demographics
NPI:1013787241
Name:KNUCKLES, JENNIFER (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:KNUCKLES
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:PO BOX 257
Mailing Address - Street 2:
Mailing Address - City:ALBA
Mailing Address - State:TX
Mailing Address - Zip Code:75410-0257
Mailing Address - Country:US
Mailing Address - Phone:858-663-3288
Mailing Address - Fax:
Practice Address - Street 1:169 E HOLLEY ST
Practice Address - Street 2:
Practice Address - City:ALBA
Practice Address - State:TX
Practice Address - Zip Code:75410-2658
Practice Address - Country:US
Practice Address - Phone:972-587-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor