Provider Demographics
NPI:1700216801
Name:KOCKEN CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:KOCKEN CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-915-5929
Mailing Address - Street 1:1783 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-7680
Mailing Address - Country:US
Mailing Address - Phone:920-915-5929
Mailing Address - Fax:
Practice Address - Street 1:920 MAIN AVE
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-1306
Practice Address - Country:US
Practice Address - Phone:920-915-5929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI497512111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty