Provider Demographics
NPI:1689970287
Name:KNOWLTON, CHRISTOPHER DEROSS
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DEROSS
Last Name:KNOWLTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 N DIXIE DOWNS RD
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4206
Mailing Address - Country:US
Mailing Address - Phone:435-652-4354
Mailing Address - Fax:435-652-4354
Practice Address - Street 1:960 N DIXIE DOWNS RD
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4206
Practice Address - Country:US
Practice Address - Phone:435-652-4354
Practice Address - Fax:435-652-4354
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other