NPIMap

Organization Active NPI

Community Chiropractic Spine & Sport PLLC

  • Chiropractor
  • Essex JCT, VT
National Provider Identifier
1326516089
Registry record updated Nov 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
COMMUNITY CHIROPRACTIC SPINE & SPORT PLLC
Practice address
8 Essex Way Ste 204
Essex JCT, VT 05452-3422
Phone
(802) 872-9788
Fax
(802) 878-1209
NPI assigned
Nov 10, 2018
Last updated
Nov 10, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Darryl Lawrence Koch, DCNPI 1467419887
Title
President
Phone
(802) 233-3675

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X NU Primary
Naturopath 175F00000X NU
Physical Therapist 225100000X NU

Addresses

Primary practice location

8 Essex Way Ste 204
Essex JCT, VT 05452-3422

Mailing address

8 Essex Way Ste 204
Essex JCT, VT 05452-3422
Phone (802) 872-9788

Other identifiers 1

IdentifierTypeStateIssuer
OVN3616MedicaidVT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1541808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541808000000",
    "number": "1326516089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 ESSEX WAY STE 204",
            "city": "ESSEX JCT",
            "state": "VT",
            "postal_code": "054523422",
            "telephone_number": "802-872-9788",
            "fax_number": "802-878-1209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 ESSEX WAY STE 204",
            "city": "ESSEX JCT",
            "state": "VT",
            "postal_code": "054523422",
            "telephone_number": "802-872-9788",
            "fax_number": "802-878-1209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CHIROPRACTIC SPINE & SPORT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-10",
        "last_updated": "2018-11-10",
        "status": "A",
        "authorized_official_last_name": "KOCH",
        "authorized_official_first_name": "DARRYL",
        "authorized_official_middle_name": "LAWRENCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "802-233-3675",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "175F00000X",
            "taxonomy_group": "",
            "desc": "Naturopath",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OVN3616",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Essex JCT, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.