Provider Demographics
NPI:1790825719
Name:DR. LYNNE M. KOCH, PC
Entity Type:Organization
Organization Name:DR. LYNNE M. KOCH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-595-4275
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC1909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty