Provider Demographics
NPI:1952585200
Name:KNIGHTLY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:KNIGHTLY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:KNIGHTLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-295-2141
Mailing Address - Street 1:3627 30TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3508
Mailing Address - Country:US
Mailing Address - Phone:619-295-2141
Mailing Address - Fax:619-295-2142
Practice Address - Street 1:3627 30TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-3508
Practice Address - Country:US
Practice Address - Phone:619-295-2141
Practice Address - Fax:619-295-2142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27792111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty