Provider Demographics
NPI:1336177286
Name:KOCH, PAUL ERIK (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ERIK
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 1:662 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-2402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:259 FISH POND RD
Practice Address - Street 2:STE. 8
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-3046
Practice Address - Country:US
Practice Address - Phone:856-582-7800
Practice Address - Fax:856-582-7557
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU50874Medicare UPIN
NJK0416630Medicare ID - Type Unspecified