Provider Demographics
NPI:1265569834
Name:KOCH, CHRISTOPHER JONATHAN (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JONATHAN
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 1:7717 W DEER VALLEY RD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2102
Mailing Address - Country:US
Mailing Address - Phone:623-512-4040
Mailing Address - Fax:623-512-4040
Practice Address - Street 1:7717 W DEER VALLEY RD
Practice Address - Street 2:SUITE 135
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2102
Practice Address - Country:US
Practice Address - Phone:623-512-4040
Practice Address - Fax:623-512-4040
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0243770OtherBLUE CROSS BLUE SHIELD
AZ23-22036OtherSTATE COMPENSATION FUND
AZAZ0243770OtherBLUE CROSS BLUE SHIELD