Provider Demographics
NPI:1518564996
Name:ADA KNECHT DOM, LLC
Entity Type:Organization
Organization Name:ADA KNECHT DOM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNECHT
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:305-342-0076
Mailing Address - Street 1:14075 SW 72ND CT
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33158-1263
Mailing Address - Country:US
Mailing Address - Phone:305-342-0076
Mailing Address - Fax:
Practice Address - Street 1:195 GIRALDA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5208
Practice Address - Country:US
Practice Address - Phone:305-567-1973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty