Healthcare Provider Details

I. General information

NPI: 1609025592
Provider Name (Legal Business Name): KOCA CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 N 120TH ST SUITE D6
OMAHA NE
68164-3479
US

IV. Provider business mailing address

2085 N 120TH ST SUITE D6
OMAHA NE
68164-3479
US

V. Phone/Fax

Practice location:
  • Phone: 402-496-4570
  • Fax: 402-496-8972
Mailing address:
  • Phone: 402-496-4570
  • Fax: 402-496-8972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. LYLE E KOCA
Title or Position: OWNER
Credential: D.C.
Phone: 402-496-4570