Provider Demographics
NPI:1811091242
Name:KNOWLES, GEOFFREY WALTER (DC)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:WALTER
Last Name:KNOWLES
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 1:6 WILDERNESS WAY
Mailing Address - Street 2:
Mailing Address - City:BASS HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04653-0397
Mailing Address - Country:US
Mailing Address - Phone:207-244-9689
Mailing Address - Fax:
Practice Address - Street 1:205 TREMONT RD.
Practice Address - Street 2:
Practice Address - City:BASS HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04653-0397
Practice Address - Country:US
Practice Address - Phone:207-244-5870
Practice Address - Fax:207-244-0096
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MET31542Medicare UPIN
ME067899Medicare ID - Type Unspecified