Provider Demographics
NPI:1104009810
Name:KRISTIAN F. MCCOY
Entity Type:Organization
Organization Name:KRISTIAN F. MCCOY
Other - Org Name:FLAX POND CHIROPRACTIC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIAN
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-592-8089
Mailing Address - Street 1:9 BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-2536
Mailing Address - Country:US
Mailing Address - Phone:781-592-8089
Mailing Address - Fax:781-592-8091
Practice Address - Street 1:9 BOSTON ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-2536
Practice Address - Country:US
Practice Address - Phone:781-592-8089
Practice Address - Fax:781-592-8091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH1982111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA28215OtherHARVARD PILGRIM
MA198200OtherTUFTS HEALTH PLANS
MA1606824Medicaid
MAY36415OtherBLUE CROSS / BLUE SHIELD
MA198200OtherTUFTS HEALTH PLANS