Provider Demographics
NPI:1609077585
Name:KOSCHENE, CHERLE DIANE (DC)
Entity Type:Individual
Prefix:
First Name:CHERLE
Middle Name:DIANE
Last Name:KOSCHENE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SHERI
Other - Middle Name:
Other - Last Name:KOSCHENE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:108 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-3221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:108 E 23RD ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-3221
Practice Address - Country:US
Practice Address - Phone:970-667-8122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU06061Medicare UPIN