Provider Demographics
NPI:1255377057
Name:KNIPP II, GEORGE WALTER (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WALTER
Last Name:KNIPP II
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 1:201 BRIGHTON PARK BLVD # 2
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-3717
Mailing Address - Country:US
Mailing Address - Phone:502-695-4455
Mailing Address - Fax:502-695-0727
Practice Address - Street 1:201 BRIGHTON PARK BLVD # 2
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-3717
Practice Address - Country:US
Practice Address - Phone:502-695-4455
Practice Address - Fax:502-695-0727
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV760111N00000X
KY249286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1059297OtherWORKERS COMPENSATION
WV238485OtherMAMSI ID
WVW43523OtherMOUNTAIN STATE BC/BS
WV2202061000Medicaid
WV7073344OtherAETNA
WVBC-BSOtherMOUNTAIN STATE BC/BS
OH000000223714OtherATHEM
WV350055469OtherRAILROAD MEDICARE NUMBER
WV2202061000Medicaid
WVW43523OtherMOUNTAIN STATE BC/BS