Provider Demographics
NPI:1720696487
Name:THOMAS-KOEN, NIESHA (DC)
Entity Type:Individual
Prefix:DR
First Name:NIESHA
Middle Name:
Last Name:THOMAS-KOEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38565 LION WAY
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4428
Mailing Address - Country:US
Mailing Address - Phone:310-404-3274
Mailing Address - Fax:661-267-6742
Practice Address - Street 1:9810 LAKE FOREST BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-5425
Practice Address - Country:US
Practice Address - Phone:504-242-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor