Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 11630 | CA |
NPI | 1699900381 |
---|---|
Provider Name | Dr. Carol Ann Koch |
First Address | San Rafael, CA 94903-3708 |
Second Address | San Rafael, CA 94903-3708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2009 |
Last Update Date | 25/05/2009 |