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General NPI Number Information
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NPI Number | 1134883861
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Entity Type | Organization
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Legal Business Name | MARK KOCH DC LLC
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Dates
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Enumeration Date | 10/28/2021
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Last Update Date | 10/28/2021
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Provider Practice Location Address
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Address Line | 1055 LEGION DR
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City | ELM GROVE
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State | WI
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Zip | 53122-2202
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Country | US
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Telephone | 262-784-8232
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Fax | 262-784-4139
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Provider Business Mailing Address
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Address Line | 1055 LEGION DR
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City | ELM GROVE
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State | WI
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Zip | 53122-2202
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Country | US
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Telephone | 262-784-8232
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Fax | 262-784-4139
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | DR. MARK JAMES KOCH
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Credential | DC
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Telephone | 262-784-8232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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