Provider Demographics
NPI:1659409704
Name:MILLER KOCH, DIANE REGINA (DC)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:REGINA
Last Name:MILLER 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 1:7717 W DEER VALLEY RD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2102
Mailing Address - Country:US
Mailing Address - Phone:623-512-4040
Mailing Address - Fax:623-512-4043
Practice Address - Street 1:7717 W DEER VALLEY RD
Practice Address - Street 2:SUITE 135
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2102
Practice Address - Country:US
Practice Address - Phone:623-512-4040
Practice Address - Fax:623-512-4043
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor