| Mark Koch DC LLC | |
|
1055 Legion Dr Elm Grove WI 53122-2202 | |
| (262) 784-8232 | |
| (262) 784-4139 |
| Full Name | Mark Koch DC LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 1055 Legion Dr, Elm Grove, Wisconsin |
| Authorized Official Name and Position | Mark James Koch (OWNER DOCTOR) |
| Authorized Official Contact | 2627848232 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark Koch DC LLC 1055 Legion Dr Elm Grove WI 53122-2202 Ph: (262) 784-8232 | Mark Koch DC LLC 1055 Legion Dr Elm Grove WI 53122-2202 Ph: (262) 784-8232 |
| NPI Number | 1134883861 |
|---|---|
| Provider Enumeration Date | 10/28/2021 |
| Last Update Date | 10/28/2021 |
| Certification Date | 10/28/2021 |
| Medicare PECOS PAC ID | 4183019516 |
|---|---|
| Medicare Enrollment ID | O20220321002194 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134883861 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Primary |
| 111N00000X | Chiropractor | (NU) | Secondary |
| Provider Name | Mark J Koch |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1699828251 PECOS PAC ID: 6204099617 Enrollment ID: I20120523000086 |
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