Provider Demographics
NPI:1831694983
Name:KNAPP, CONNOR WADE (DC)
Entity type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:WADE
Last Name:KNAPP
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 1:342 RICHARD TER SE APT BMT
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-1719
Mailing Address - Country:US
Mailing Address - Phone:231-215-0002
Mailing Address - Fax:
Practice Address - Street 1:6807 CASCADE RD SE STE D
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8722
Practice Address - Country:US
Practice Address - Phone:231-215-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor