Healthcare Provider Details

I. General information

NPI: 1790974335
Provider Name (Legal Business Name): RICHARD J KOCH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RICHARD J KOCH DC

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 IRMO DR
COLUMBIA SC
29212-8607
US

IV. Provider business mailing address

7520 IRMO DR
COLUMBIA SC
29212-8607
US

V. Phone/Fax

Practice location:
  • Phone: 803-732-5678
  • Fax:
Mailing address:
  • Phone: 803-732-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number846
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: