Organization
BRADLEY KOEHN CHIROPRACTIC CORPORATION
Active
Other names
Lifeline Chiropractic Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY D KOEHN DC (DOCTOR OWNER)
(209) 238-3333
Entity
Organization
Contact information
Practice address
321 E GRANGER AVE, MODESTO, CA 95350-4304
(209) 238-3333
(209) 238-3249
Mailing address
321 E GRANGER AVE, MODESTO, CA 95350-4304
(209) 238-3333
(209) 238-3249
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC230341
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ07887Z
BLUE SHIELD
—
Enumeration date
10/13/2006
Last updated
10/05/2007
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