Provider Demographics
NPI:1063655421
Name:MCCOY, NICHOLAS AARON (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:AARON
Last Name:MCCOY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N. HWY 52 SUITE D #127
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461
Mailing Address - Country:US
Mailing Address - Phone:843-761-4470
Mailing Address - Fax:843-695-7932
Practice Address - Street 1:112 BROUGHTON RD
Practice Address - Street 2:STE B
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-4021
Practice Address - Country:US
Practice Address - Phone:843-761-4470
Practice Address - Fax:843-695-7932
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01593884OtherRAILROAD MEDICARE PTAN
SCCH3453Medicaid
SCCH3453Medicaid