Provider Demographics
NPI:1609025592
Name:KOCA CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:KOCA CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOCA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-496-4570
Mailing Address - Street 1:2085 N 120TH ST
Mailing Address - Street 2:SUITE D6
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3479
Mailing Address - Country:US
Mailing Address - Phone:402-496-4570
Mailing Address - Fax:402-496-8972
Practice Address - Street 1:2085 N 120TH ST
Practice Address - Street 2:SUITE D6
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3479
Practice Address - Country:US
Practice Address - Phone:402-496-4570
Practice Address - Fax:402-496-8972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE087339Medicare PIN