Knickerbocker, Kenneth Lance
Knickerbocker, Kenneth Lance is an individual health care provider with primary practice located at 19900 State Route 739 , Marysville OH 43040-9256. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Knickerbocker, Kenneth Lance can be contacted via phone (937) 642-0298.Contact Information
Primary practice address
19900 State Route 739
Marysville OH 43040-9256
Phone: (937) 642-0298
Fax: (937) 645-8329
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 34 . 008177 | Ohio |
Profile Details
| NPI number | 1316157472 |
|---|---|
| LBN Legal business name | Knickerbocker, Kenneth Lance |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 23rd, 2007 |
| Last updated | Dec 16th, 2009 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1316157472 | NPPES |
| Virginia | Other | 0102036816 | STATE LICENSE |
| Virginia | Other | 3203 | STATE LICENSE |
| Virginia | Other | 34 . 008177 | STATE LICENSE |
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