Individual
KYLE ANDREW KOENKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1066 N POWER RD STE 104, MESA, AZ 85205-5709
(480) 830-7288
(480) 985-7255
Mailing address
1066 N POWER RD STE 104, MESA, AZ 85205-5709
(480) 830-7288
(480) 985-7255
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
7157
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0943870
BCBS
AZ
01
—
RRP00086254
RRBCBS
AZ
Enumeration date
12/11/2006
Last updated
07/08/2007
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