Provider Demographics
NPI:1013136530
Name:KOONTZ, WILLIAM L (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:KOONTZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:L
Other - Last Name:KOONTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3031 S ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80916-3201
Mailing Address - Country:US
Mailing Address - Phone:719-392-1218
Mailing Address - Fax:719-392-0732
Practice Address - Street 1:3031 S ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-3201
Practice Address - Country:US
Practice Address - Phone:719-392-1218
Practice Address - Fax:719-392-0732
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC11403Medicare PIN