Provider Demographics
NPI:1184812158
Name:MEGANNE GISELLA STIFTER-KNOLL
Entity type:Organization
Organization Name:MEGANNE GISELLA STIFTER-KNOLL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGANNE
Authorized Official - Middle Name:GISELLA
Authorized Official - Last Name:STIFTER-KNOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-395-9827
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:LESTER PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55354-0026
Mailing Address - Country:US
Mailing Address - Phone:320-395-9827
Mailing Address - Fax:320-395-9837
Practice Address - Street 1:32 JUNIPER ST N
Practice Address - Street 2:
Practice Address - City:LESTER PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55354-0026
Practice Address - Country:US
Practice Address - Phone:320-395-9827
Practice Address - Fax:320-395-9837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN670950800Medicaid
MN670950800Medicaid
MNC04130Medicare PIN