Healthcare Provider Details

I. General information

NPI: 1346348034
Provider Name (Legal Business Name): MARK KOCHEVAR D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11880 UPHAM ST UNIT F
BROOMFIELD CO
80020-2786
US

IV. Provider business mailing address

11880 UPHAM ST UNIT F
BROOMFIELD CO
80020-2786
US

V. Phone/Fax

Practice location:
  • Phone: 303-465-9464
  • Fax:
Mailing address:
  • Phone: 303-465-9464
  • Fax: 303-465-0126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3554
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: