Provider Demographics
NPI:1952666059
Name:KOCH, MICHAEL JAMES (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
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 1:7030 S YOSEMITE ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2026
Mailing Address - Country:US
Mailing Address - Phone:303-721-9984
Mailing Address - Fax:303-267-7304
Practice Address - Street 1:7030 S YOSEMITE ST
Practice Address - Street 2:SUITE 220
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2026
Practice Address - Country:US
Practice Address - Phone:303-721-9984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor