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General NPI Number Information
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NPI Number | 1649460346
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Entity Type | Organization
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Legal Business Name | ROBERT A KOCH D.C.P.C.
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Dates
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Enumeration Date | 07/28/2007
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 14720 FORT ST
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City | SOUTHGATE
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State | MI
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Zip | 48195-1217
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Country | US
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Telephone | 734-281-2400
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Fax | 734-281-1795
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Provider Business Mailing Address
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Address Line | 14720 FORT ST
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City | SOUTHGATE
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State | MI
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Zip | 48195-1217
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Country | US
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Telephone | 734-281-2400
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Fax | 734-281-1795
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CHRISTINA ELIZABETH SNYDER
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Credential |
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Telephone | 734-281-2400
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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 | 2301004639
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License Number State | MI
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