Provider Demographics
NPI:1831397991
Name:KOCH, ROBERT JORDAN (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JORDAN
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 1:415 E MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4554
Mailing Address - Country:US
Mailing Address - Phone:407-423-1616
Mailing Address - Fax:407-423-1889
Practice Address - Street 1:415 E MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4554
Practice Address - Country:US
Practice Address - Phone:407-423-1616
Practice Address - Fax:407-423-1889
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9363111N00000X
GACHIR007476111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAE2582Medicare PIN