Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2011019742 | MO |
N | 111NR0400X | Rehabilitation Chiropractor | 2011019742 | MO |
N | 111NX0100X | Occupational Health | 2011019742 | MO |
NPI | 1770870768 |
---|---|
Provider Name | Dr. Megan Nicole Knox |
First Address | Pineville, MO 64856-8204 |
Second Address | Pineville, MO 64856-8204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2011 |
Last Update Date | 09/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018220001 | MEDICARE PTAN (01) | MO |