Kenneth Lance Knickerbocker, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

34 . 008177 Issued in OH

Practice address

19900 State Route 739
Marysville, OH 43040-9256

Phone

(937) 642-0298

Fax

(937) 645-8329

NPI assigned

May 23, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Health Partners Limited

  • Occupational Medicine Clinic/Center
  • Marysville, OH
  • NPI 1134243322
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260921600000",
    "number": "1316157472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19900 STATE ROUTE 739",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430409256",
            "telephone_number": "937-642-0298",
            "fax_number": "937-645-8329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19900 STATE ROUTE 739",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430409256",
            "telephone_number": "937-642-0298",
            "fax_number": "937-645-8329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNICKERBOCKER",
        "first_name": "KENNETH",
        "middle_name": "LANCE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2009-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34 . 008177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "0102036816",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "3203",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "34 . 008177",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cheryl K Kirkby, MD
• Kara Kish, PHARMD
• Paul E Kitzmiller II, LPC
• John Edward Kleinman
• Keren Grace Knapp, COTA/L
• Jaclyn Koester
• Luke Robert Kontras, PT, DPT
• Stephanie Kracker, PA-C
• Brianne Nicole Kramer, L.P.C.
• Katelin Kreinbrink, DDS

• Family Medicine Physician in Marysville, OH
• Providers in Marysville, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.