MEDICARE: KEVIN PAUL KOCH 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	DC002254L	PA

General Provider Information

NPI Number	:	1215985817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN PAUL KOCH DC

Provider Business Mailing Address
First Line	:	223 MULBERRY ST
Second Line	:
City	:	NEWPORT
State	:	PA
Zip	:	17074-1421
Country	:	US
Telephone Number	:	717-567-3158
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 MULBERRY ST
Second Line	:
City	:	NEWPORT
State	:	PA
Zip	:	17074-1421
Country	:	US
Telephone Number	:	717-567-3158
Fax Number	:

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	09/26/2011

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