Provider Demographics
NPI:1649227067
Name:KOCH, AMY (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:KOCH
Suffix:
Gender:F
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:PO BOX 735
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-0735
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1851 SCHOETTLER RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5529
Practice Address - Country:US
Practice Address - Phone:636-230-1798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010376111N00000X
MO2013004583111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06832013OtherBLUE CROSS/BLUE SHIELD
IL61032030OtherDEPARTMENT OF LABOR
IL06832013OtherBLUE CROSS/BLUE SHIELD
IL06832013OtherBLUE CROSS/BLUE SHIELD