Provider Demographics
NPI:1598824443
Name:KOEHN, MICHAEL ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANDREW
Last Name:KOEHN
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 1:325 OMAHA ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2803
Mailing Address - Country:US
Mailing Address - Phone:605-718-5329
Mailing Address - Fax:605-718-5334
Practice Address - Street 1:325 OMAHA ST
Practice Address - Street 2:SUITE 5
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2803
Practice Address - Country:US
Practice Address - Phone:605-718-5329
Practice Address - Fax:605-718-5334
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDP00235015OtherRAILROAD MEDICARE #
SD0007238OtherBCBC PPO#
SD192934800OtherDEPT. OF LABOR WORKCOMP #
SD192934800OtherDEPT. OF LABOR WORKCOMP #
SDU29960Medicare UPIN