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General NPI Number Information
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NPI Number | 1326516089
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Entity Type | Organization
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Legal Business Name | COMMUNITY CHIROPRACTIC SPINE & SPORT PLLC
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Dates
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Enumeration Date | 11/10/2018
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Last Update Date | 11/10/2018
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Provider Practice Location Address
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Address Line | 8 ESSEX WAY STE 204
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City | ESSEX JCT
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State | VT
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Zip | 05452-3422
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Country | US
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Telephone | 802-872-9788
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Fax | 802-878-1209
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Provider Business Mailing Address
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Address Line | 8 ESSEX WAY STE 204
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City | ESSEX JCT
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State | VT
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Zip | 05452-3422
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Country | US
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Telephone | 802-872-9788
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Fax | 802-878-1209
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DARRYL LAWRENCE KOCH
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Credential | DC
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Telephone | 802-233-3675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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