Provider Demographics
NPI:1104376029
Name:A HEALTHY COMMUNITY
Entity Type:Organization
Organization Name:A HEALTHY COMMUNITY
Other - Org Name:COLLEEN MCCOY DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-588-9640
Mailing Address - Street 1:6050 COMMERCE BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2101
Mailing Address - Country:US
Mailing Address - Phone:707-588-9640
Mailing Address - Fax:707-588-9675
Practice Address - Street 1:6050 COMMERCE BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2101
Practice Address - Country:US
Practice Address - Phone:707-588-9640
Practice Address - Fax:707-588-9675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty