Provider Demographics
NPI:1720057276
Name:KNUTSON, DUSTIN CRAIG (DC)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:CRAIG
Last Name:KNUTSON
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 1:1334 SONG SPARROW WAY
Mailing Address - Street 2:
Mailing Address - City:HANAHAN
Mailing Address - State:SC
Mailing Address - Zip Code:29410-8410
Mailing Address - Country:US
Mailing Address - Phone:843-270-1675
Mailing Address - Fax:
Practice Address - Street 1:2165 ASHLEY PHOSPHATE RD
Practice Address - Street 2:SUITE A AND B
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4157
Practice Address - Country:US
Practice Address - Phone:843-824-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2239OtherSTATE LICENSE NUMBER
SCU833028199Medicare ID - Type Unspecified