Provider Demographics
NPI:1912915042
Name:KOENIG, JOE DEVIN (DC)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:DEVIN
Last Name:KOENIG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 STATE HWY 206
Mailing Address - Street 2:
Mailing Address - City:CISCO
Mailing Address - State:TX
Mailing Address - Zip Code:76437
Mailing Address - Country:US
Mailing Address - Phone:254-442-4878
Mailing Address - Fax:254-442-3754
Practice Address - Street 1:1510 STATE HWY 206
Practice Address - Street 2:
Practice Address - City:CISCO
Practice Address - State:TX
Practice Address - Zip Code:76437
Practice Address - Country:US
Practice Address - Phone:254-442-4878
Practice Address - Fax:254-442-3754
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX002000001Medicaid
TX605701Medicare ID - Type Unspecified
TX002000001Medicaid