Provider Demographics
NPI:1396840625
Name:KNECHT CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:KNECHT CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNECHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-777-5242
Mailing Address - Street 1:2631 S HORNER BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-8032
Mailing Address - Country:US
Mailing Address - Phone:919-777-5242
Mailing Address - Fax:919-776-7494
Practice Address - Street 1:2631 SOUTH HORNER BOULEVARD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332
Practice Address - Country:US
Practice Address - Phone:919-777-5242
Practice Address - Fax:919-776-7494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0828TOtherBCBS
NC890828TMedicaid
NC2333238Medicare ID - Type Unspecified
NC2451608BMedicare ID - Type Unspecified
NC890828TMedicaid