Provider Demographics
NPI:1811909286
Name:JODI L KNOTT CHIROPRACTOR PC
Entity type:Organization
Organization Name:JODI L KNOTT CHIROPRACTOR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:L
Authorized Official - Last Name:KNOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-692-0779
Mailing Address - Street 1:99 ROUND SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6435
Mailing Address - Country:US
Mailing Address - Phone:631-692-0779
Mailing Address - Fax:631-692-0783
Practice Address - Street 1:99 ROUND SWAMP RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6435
Practice Address - Country:US
Practice Address - Phone:631-692-0779
Practice Address - Fax:631-692-0783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC06504OtherWORKERS COMP.
NYX6R341OtherEMPIRE BC/BS
NY129047OtherACN
NY5185026OtherAETNA/US HEALTH CARE
NY5897704OtherGHI
NYC06504OtherNY NO FAULT
NY856310OtherUNITED HEALTH CARE
NYP938436OtherOXFORD
NY5897704OtherGHI