Provider Demographics
NPI:1790766384
Name:KOC, STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:KOC
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:KOC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2399 12TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2149
Mailing Address - Country:US
Mailing Address - Phone:503-365-8399
Mailing Address - Fax:
Practice Address - Street 1:2399 12TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2149
Practice Address - Country:US
Practice Address - Phone:503-365-8399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR106809Medicare ID - Type Unspecified
ORT82591Medicare UPIN