Individual
DR. JAY D KOONTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
118 S MAIN ST, NORTH WEBSTER, IN 46555
(574) 834-7855
(574) 834-7935
Mailing address
PO BOX 579, NORTH WEBSTER, IN 46555-0579
(574) 834-7855
(574) 834-7935
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08001901A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000210120
ANTHEM BC BS
IN
Enumeration date
12/12/2006
Last updated
02/12/2010
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