Provider Demographics
NPI:1922871334
Name:KOCH CHIROPRACTIC AND WELLNESS CENTER
Entity Type:Organization
Organization Name:KOCH CHIROPRACTIC AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DORAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-256-9616
Mailing Address - Street 1:1990 GODFREY DR
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-7908
Mailing Address - Country:US
Mailing Address - Phone:715-256-9616
Mailing Address - Fax:715-256-9618
Practice Address - Street 1:N430 WOOD DUCK DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:WI
Practice Address - Zip Code:54940-8855
Practice Address - Country:US
Practice Address - Phone:715-256-9616
Practice Address - Fax:715-256-9618
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOCH CHIROPRACTIC AND WELLNESS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty