Provider Demographics
NPI:1760521363
Name:KOCH, CORY L (DC)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:L
Last Name:KOCH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 E 151ST ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-2969
Mailing Address - Country:US
Mailing Address - Phone:913-768-0000
Mailing Address - Fax:913-768-0758
Practice Address - Street 1:2139 E 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-2969
Practice Address - Country:US
Practice Address - Phone:913-768-0000
Practice Address - Fax:913-768-0758
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4400204OtherUNITED HEALTH CARE
KS11718OtherPRINCIPAL INSURANCE
KS497955OtherBCBS OF KS
KS25133OtherCOVENTRY INSURANCE
KS4595906OtherAETNA INSURANCE
KS18541018OtherBCBS OF KC
KS497955OtherBCBS OF KS
KS18541018OtherBCBS OF KC