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Individual

DR. MARK JAMES KOCH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3460
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
38926800
WI
Enumeration date
01/18/2007
Last updated
06/30/2008
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