Provider Demographics
NPI:1205883170
Name:KNOTTS, KRAIG KURTIS (DC)
Entity type:Individual
Prefix:DR
First Name:KRAIG
Middle Name:KURTIS
Last Name:KNOTTS
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 1:547 S FITNESS PL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6552
Mailing Address - Country:US
Mailing Address - Phone:208-939-3986
Mailing Address - Fax:208-939-7186
Practice Address - Street 1:547 S FITNESS PL
Practice Address - Street 2:SUITE 110
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6552
Practice Address - Country:US
Practice Address - Phone:208-939-3986
Practice Address - Fax:208-939-7186
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1073111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC-4272OtherBLUE CROSS OF IDAHO