Provider Demographics
NPI:1285827576
Name:KOCH, THOMAS GREGORY (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:GREGORY
Last Name:KOCH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 N WORTHEN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801
Mailing Address - Country:US
Mailing Address - Phone:509-665-9518
Mailing Address - Fax:509-662-1607
Practice Address - Street 1:18 N WORTHEN
Practice Address - Street 2:SUITE 100
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801
Practice Address - Country:US
Practice Address - Phone:509-665-9518
Practice Address - Fax:509-662-1607
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor