Provider Demographics
NPI:1467419887
Name:KOCH, DARRYL LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:LAWRENCE
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 1:8 ESSEX WAY
Mailing Address - Street 2:STE 204
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3422
Mailing Address - Country:US
Mailing Address - Phone:802-872-9788
Mailing Address - Fax:802-878-1209
Practice Address - Street 1:8 ESSEX WAY
Practice Address - Street 2:STE 204
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3422
Practice Address - Country:US
Practice Address - Phone:802-872-9788
Practice Address - Fax:802-879-0370
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX08954111N00000X
VT006-0001141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN3616Medicaid
VN3616Medicare PIN
U70143Medicare UPIN