Provider Demographics
NPI:1487948204
Name:KNECHT, MICHAEL DONALD
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DONALD
Last Name:KNECHT
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 1:12651 MCGREGOR BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4467
Mailing Address - Country:US
Mailing Address - Phone:239-243-8810
Mailing Address - Fax:239-243-8804
Practice Address - Street 1:12651 MCGREGOR BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4467
Practice Address - Country:US
Practice Address - Phone:239-243-8810
Practice Address - Fax:239-243-8804
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011921111N00000X
FLCH11188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor