Provider Demographics
NPI:1437200839
Name:KOCH, RYAN PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:PATRICK
Last Name:KOCH
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 1:2600 GATEWAY AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0568
Mailing Address - Country:US
Mailing Address - Phone:701-751-1161
Mailing Address - Fax:
Practice Address - Street 1:2600 GATEWAY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0568
Practice Address - Country:US
Practice Address - Phone:701-751-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND785111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
30415OtherBCBS ND PROVIDER NUMBER
ND07066-001OtherBCBS ND CLINIC/GROUP #
30415OtherBCBS ND PROVIDER NUMBER