Provider Demographics
NPI:1720167117
Name:KNAFLA CHIROPRACTIC CLINIC, LTD
Entity Type:Organization
Organization Name:KNAFLA CHIROPRACTIC CLINIC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KNAFLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:763-389-5803
Mailing Address - Street 1:900 S RUM RIVER DR STE 102
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-2239
Mailing Address - Country:US
Mailing Address - Phone:763-389-5803
Mailing Address - Fax:763-389-0063
Practice Address - Street 1:900 S RUM RIVER DR
Practice Address - Street 2:STE 101
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-2245
Practice Address - Country:US
Practice Address - Phone:763-389-5803
Practice Address - Fax:763-389-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-04
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3105111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
350045207OtherPALMETTO GBA RAILROAD
MN991528100Medicaid
MN44-40199OtherMEDICA
MNCC00463OtherCC/LANDMARK
MN4C215-KNOtherBLUE CROSS BLUE SHIELD OF MN GRP
MN4C216-KNOtherBLUE CROSS BLUE SHIELD OF MN
MN4C216-KNOtherBLUE CROSS BLUE SHIELD OF MN
MNCC00463OtherCC/LANDMARK