Provider Demographics
NPI:1881769826
Name:KOCHER, JEFFREY ALAN (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:KOCHER
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 1:731 S WEST ST
Mailing Address - Street 2:PO BOX 96
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450
Mailing Address - Country:US
Mailing Address - Phone:618-392-5511
Mailing Address - Fax:618-392-2433
Practice Address - Street 1:731 S WEST ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450
Practice Address - Country:US
Practice Address - Phone:618-392-5511
Practice Address - Fax:618-392-2433
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL295571Medicare ID - Type Unspecified
L22380Medicare UPIN