Provider Demographics
NPI:1659429215
Name:KOC, JOHN JEROME III (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JEROME
Last Name:KOC
Suffix:III
Gender:M
Credentials:DC
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Mailing Address - Street 1:4045 E BELL RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2236
Mailing Address - Country:US
Mailing Address - Phone:480-703-1834
Mailing Address - Fax:602-493-2399
Practice Address - Street 1:4045 E BELL RD
Practice Address - Street 2:SUITE 107
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2236
Practice Address - Country:US
Practice Address - Phone:480-703-1834
Practice Address - Fax:602-493-2399
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2013-06-11
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Provider Licenses
StateLicense IDTaxonomies
AZ6076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ104876Medicare PIN