Provider Demographics
NPI:1215115068
Name:KOCH, JOSHUA LAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:LAYNE
Last Name:KOCH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:2304 S POST RD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-7524
Mailing Address - Country:US
Mailing Address - Phone:405-455-7555
Mailing Address - Fax:405-455-7556
Practice Address - Street 1:1712 S POST RD STE B
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-6614
Practice Address - Country:US
Practice Address - Phone:405-455-7555
Practice Address - Fax:405-455-7556
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3870111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK700222Medicare PIN