Provider Demographics
NPI:1053315663
Name:COY, RICHARD C (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:COY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 S STATE ROUTE 157
Mailing Address - Street 2:STE 1
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-1041
Mailing Address - Country:US
Mailing Address - Phone:618-288-3610
Mailing Address - Fax:618-288-9879
Practice Address - Street 1:3407 S STATE ROUTE 157
Practice Address - Street 2:STE 1
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-1041
Practice Address - Country:US
Practice Address - Phone:618-288-3610
Practice Address - Fax:618-288-9879
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005331111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215809OtherMEDICARE
IL44-01024OtherUNITED HEALTH CARE
MO7422OtherALLIANCE BLUE CROSS
IL47722OtherCMR
IL180267OtherHEALTHLINK
IL47722OtherGHP
IL6082091OtherBLUE CROSS BLUE SHIELD
IL215809OtherMEDICARE