Healthcare Provider Details

I. General information

NPI: 1871905489
Provider Name (Legal Business Name): DANIEL JAMES EDWARD KOCH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2014
Last Update Date: 05/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 BROADWAY
IMPERIAL NE
69033-3162
US

IV. Provider business mailing address

PO BOX 696
IMPERIAL NE
69033-0696
US

V. Phone/Fax

Practice location:
  • Phone: 308-882-5532
  • Fax:
Mailing address:
  • Phone: 308-882-5532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1800
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: