Provider Demographics
NPI:1255330270
Name:KNOCHE, RANDY RUSSELL (DC)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:RUSSELL
Last Name:KNOCHE
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 1:1802 CHAPEL HILLS DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3765
Mailing Address - Country:US
Mailing Address - Phone:719-531-7188
Mailing Address - Fax:719-531-0880
Practice Address - Street 1:1802 CHAPEL HILLS DR
Practice Address - Street 2:SUITE E
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3765
Practice Address - Country:US
Practice Address - Phone:719-531-7188
Practice Address - Fax:719-531-0880
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO801812Medicare ID - Type Unspecified
COU47805Medicare UPIN