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Organization
COMMUNITY CHIROPRACTIC SPINE & SPORT PLLC
Active
Organization
COMMUNITY CHIROPRACTIC SPINE & SPORT PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DARRYL LAWRENCE KOCH DC (PRESIDENT)
(802) 233-3675
Entity
Organization
Contact information
Practice address
8 ESSEX WAY STE 204, ESSEX JCT, VT 05452-3422
(802) 872-9788
(802) 878-1209
Mailing address
8 ESSEX WAY STE 204, ESSEX JCT, VT 05452-3422
(802) 872-9788
(802) 878-1209
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
175F00000X
Naturopath
—
—
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OVN3616
—
VT
Enumeration date
11/10/2018
Last updated
11/10/2018
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