Active NPI
Gary Knutson, DC
- Internist Chiropractor
- Bloomington, IN
National Provider Identifier
1821196353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internist Chiropractor
- License
- 08000749A
- Practice address
- 840 W 17TH St Ste 5
Bloomington, IN 47404-3379 - Phone
- (812) 339-5839
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internist Chiropractor | 111NI0900X | 08000749A | IN | Primary |
Addresses
Primary practice location
840 W 17TH St Ste 5
Bloomington, IN 47404-3379
Mailing address
840 W 17TH St Ste 5
Bloomington, IN 47404-3379
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000215982 | Other | IN | BLUE CROSS/BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199836800000",
"number": "1821196353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "840 W 17TH ST STE 5",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474043379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "840 W 17TH ST STE 5",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474043379",
"telephone_number": "812-339-5839"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KNUTSON",
"first_name": "GARY",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2008-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "111NI0900X",
"taxonomy_group": "",
"desc": "Chiropractor, Internist",
"state": "IN",
"license": "08000749A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD",
"identifier": "000000215982",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.