Provider Demographics
NPI:1821137431
Name:KLOCH, DAVID A (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:KLOCH
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 1:771 WINTON RD S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1603
Mailing Address - Country:US
Mailing Address - Phone:585-473-5920
Mailing Address - Fax:
Practice Address - Street 1:771 WINTON RD S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-1603
Practice Address - Country:US
Practice Address - Phone:585-473-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008286-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO8286-9OtherWORK COMP #
NY14220BMedicare ID - Type Unspecified
NYU62617Medicare UPIN