Healthcare Provider Details

I. General information

NPI: 1215115068
Provider Name (Legal Business Name): JOSHUA LAYNE KOCH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 S POST RD STE B
MIDWEST CITY OK
73130-6614
US

IV. Provider business mailing address

2304 S POST RD
MIDWEST CITY OK
73130-7524
US

V. Phone/Fax

Practice location:
  • Phone: 405-455-7555
  • Fax: 405-455-7556
Mailing address:
  • Phone: 405-455-7555
  • Fax: 405-455-7556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3870
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: