Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 3870 | OK |
NPI | 1215115068 |
---|---|
Provider Name | Dr. Joshua Layne Koch |
First Address | Midwest City, OK 73130-7524 |
Second Address | Midwest City, OK 73130-6614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2008 |
Last Update Date | 13/11/2018 |