Individual
DR. GARY KNUTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
840 W 17TH ST STE 5, BLOOMINGTON, IN 47404-3379
(812) 339-5839
Mailing address
840 W 17TH ST STE 5, BLOOMINGTON, IN 47404-3379
Taxonomy
Speciality
Code
Description
License number
State
111NI0900X
Internist Chiropractor
Primary
08000749A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000215982
BLUE CROSS/BLUE SHIELD
IN
Enumeration date
09/20/2006
Last updated
01/09/2008
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