Provider Demographics
NPI:1790974335
Name:KOCH, RICHARD J (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:KOCH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:J
Other - Last Name:KOCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:7520 IRMO DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8607
Mailing Address - Country:US
Mailing Address - Phone:803-732-5678
Mailing Address - Fax:
Practice Address - Street 1:7520 IRMO DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-8607
Practice Address - Country:US
Practice Address - Phone:803-732-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor