Provider Demographics
NPI:1174779169
Name:KNOWLES, JUDITH-ANN MARIE (DC)
Entity type:Individual
Prefix:
First Name:JUDITH-ANN
Middle Name:MARIE
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 W. UNIVERSITY BLVD
Mailing Address - Street 2:#17706
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209
Mailing Address - Country:US
Mailing Address - Phone:817-905-4369
Mailing Address - Fax:972-645-2175
Practice Address - Street 1:4400 W. UNIVERSITY BLVD
Practice Address - Street 2:#17706
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209
Practice Address - Country:US
Practice Address - Phone:817-905-4369
Practice Address - Fax:972-645-2175
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor