Provider Demographics
NPI:1932797461
Name:KNOX, KEENAN (DC)
Entity Type:Individual
Prefix:
First Name:KEENAN
Middle Name:
Last Name:KNOX
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 1:46 BANGOR ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-4870
Mailing Address - Country:US
Mailing Address - Phone:207-622-0131
Mailing Address - Fax:207-622-2144
Practice Address - Street 1:46 BANGOR ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4870
Practice Address - Country:US
Practice Address - Phone:207-622-0131
Practice Address - Fax:207-622-2144
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2699111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty