Provider Demographics
NPI:1881208080
Name:KOCH, CHRISTIAN JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:JAMES
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 1:12330 JAMES ST STE B65
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8579
Mailing Address - Country:US
Mailing Address - Phone:616-595-0214
Mailing Address - Fax:
Practice Address - Street 1:12330 JAMES ST STE B65
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8579
Practice Address - Country:US
Practice Address - Phone:567-525-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301401254111NR0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation