Provider Demographics
NPI:1871905489
Name:KOCH, DANIEL JAMES EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAMES EDWARD
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:PO BOX 696
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:NE
Mailing Address - Zip Code:69033-0696
Mailing Address - Country:US
Mailing Address - Phone:308-882-5532
Mailing Address - Fax:
Practice Address - Street 1:441 BROADWAY
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:NE
Practice Address - Zip Code:69033-3162
Practice Address - Country:US
Practice Address - Phone:308-882-5532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-30
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor