Provider Demographics
NPI:1003011305
Name:KELLY A. MCCOY DC, LLC
Entity Type:Organization
Organization Name:KELLY A. MCCOY DC, LLC
Other - Org Name:OVERLAND CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-428-2225
Mailing Address - Street 1:8900 LACKLAND RD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND
Mailing Address - State:MO
Mailing Address - Zip Code:63114-5407
Mailing Address - Country:US
Mailing Address - Phone:314-428-2225
Mailing Address - Fax:314-428-3819
Practice Address - Street 1:8900 LACKLAND RD
Practice Address - Street 2:
Practice Address - City:OVERLAND
Practice Address - State:MO
Practice Address - Zip Code:63114-5407
Practice Address - Country:US
Practice Address - Phone:314-428-2225
Practice Address - Fax:314-428-3819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005013008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty