MEDICARE: DR. WILLIAM L KOONTZ DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1350	CO

General Provider Information

NPI Number	:	1013136530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM L KOONTZ DC

Provider Business Mailing Address
First Line	:	3031 S ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80916-3201
Country	:	US
Telephone Number	:	719-392-1218
Fax Number	:	719-392-0732

Provider Business Practice Location Address
First Line	:	3031 S ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80916-3201
Country	:	US
Telephone Number	:	719-392-1218
Fax Number	:	719-392-0732

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	01/12/2009

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