Provider Demographics
NPI:1598013054
Name:KNOCHE CHIROPRACTIC
Entity Type:Organization
Organization Name:KNOCHE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:KNOCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:575-623-4383
Mailing Address - Street 1:1010 S SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-2738
Mailing Address - Country:US
Mailing Address - Phone:575-623-4383
Mailing Address - Fax:575-623-7471
Practice Address - Street 1:1010 S SUNSET AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-2738
Practice Address - Country:US
Practice Address - Phone:575-623-4383
Practice Address - Fax:575-623-7471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMT40952Medicare UPIN