Provider Demographics
NPI:1073943437
Name:KOCKEN, ALEX (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:KOCKEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 MAIN AVE
Mailing Address - Street 2:STE B
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-1306
Mailing Address - Country:US
Mailing Address - Phone:920-336-2822
Mailing Address - Fax:920-347-3481
Practice Address - Street 1:920 MAIN AVE
Practice Address - Street 2:STE B
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-1306
Practice Address - Country:US
Practice Address - Phone:920-336-2822
Practice Address - Fax:920-347-3481
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4975-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor