Provider Demographics
NPI:1255687000
Name:KNUTSON, NICHOLAS J (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:J
Last Name:KNUTSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10917 BLACK DOG LN
Mailing Address - Street 2:STE 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-1461
Mailing Address - Country:US
Mailing Address - Phone:704-394-8556
Mailing Address - Fax:704-395-8556
Practice Address - Street 1:10550 INDEPENDENCE POINTE PKWY
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2690
Practice Address - Country:US
Practice Address - Phone:704-993-8045
Practice Address - Fax:704-845-8589
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor