# MARK KOCH DC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134883861
- **Authorized official:** DR. MARK JAMES KOCH DC (OWNER DOCTOR)
- **Authorized official phone:** (262) 784-8232

## Contact information

- **Practice address:** 1055 LEGION DR, ELM GROVE, WI 53122-2202
- **Practice address phone:** (262) 784-8232
- **Practice address fax:** (262) 784-4139
- **Mailing address:** 1055 LEGION DR, ELM GROVE, WI 53122-2202
- **Mailing address phone:** (262) 784-8232
- **Mailing address fax:** (262) 784-4139

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NULL | — |
| 111N00000X | Chiropractor | — | — | — |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/28/2021
- **Last updated:** 10/28/2021