Provider Demographics
NPI:1649460346
Name:ROBERT A KOCH D.C.P.C.
Entity type:Organization
Organization Name:ROBERT A KOCH D.C.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-281-2400
Mailing Address - Street 1:14720 FORT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1217
Mailing Address - Country:US
Mailing Address - Phone:734-281-2400
Mailing Address - Fax:734-281-1795
Practice Address - Street 1:14720 FORT ST
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1217
Practice Address - Country:US
Practice Address - Phone:734-281-2400
Practice Address - Fax:734-281-1795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-28
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT33835Medicaid
MI350025410OtherRAILROAD MEDICARE
MIC7938OtherACN
MI4504093OtherAETNA
MIT33835Medicare UPIN