Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 2281 | CO |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 5909 | OR |
NPI | 1265590608 |
---|---|
Provider Name | Roger G Knowles |
First Address | Medford, OR 97504-6660 |
Second Address | Lakewood, CO 80228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 19/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T60708 | (02) |