Provider Demographics
NPI:1588677827
Name:KOCH, LYNNE M (DC)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:M
Last Name:KOCH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 JOHN B WHITE SR BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-3878
Mailing Address - Country:US
Mailing Address - Phone:864-595-4275
Mailing Address - Fax:864-595-4825
Practice Address - Street 1:1524 JOHN B WHITE SR BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-3878
Practice Address - Country:US
Practice Address - Phone:864-595-4275
Practice Address - Fax:864-595-4825
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC 1909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1909Medicaid