Healthcare Provider Details

I. General information

NPI: 1336177286
Provider Name (Legal Business Name): PAUL ERIK KOCH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 FISH POND RD STE. 8
SEWELL NJ
08080-3046
US

IV. Provider business mailing address

662 JACKSON RD
MULLICA HILL NJ
08062-2402
US

V. Phone/Fax

Practice location:
  • Phone: 856-582-7800
  • Fax: 856-582-7557
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC04368
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: