Provider Demographics
NPI:1114466224
Name:KOEVEN, CHRIS (DC)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:KOEVEN
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 1:705 TODD CT
Mailing Address - Street 2:
Mailing Address - City:FERNLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89408-7558
Mailing Address - Country:US
Mailing Address - Phone:775-525-1484
Mailing Address - Fax:775-451-9504
Practice Address - Street 1:1724 C ST
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-4874
Practice Address - Country:US
Practice Address - Phone:775-525-1484
Practice Address - Fax:775-451-9504
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10258334-1202111NP0017X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor