Provider Demographics
NPI:1134671498
Name:MCCOY, TRISTAN ALDER (L AC)
Entity Type:Individual
Prefix:
First Name:TRISTAN
Middle Name:ALDER
Last Name:MCCOY
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S HOWES ST STE A105
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2871
Mailing Address - Country:US
Mailing Address - Phone:970-402-0575
Mailing Address - Fax:970-818-9325
Practice Address - Street 1:420 S HOWES ST STE A105
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2871
Practice Address - Country:US
Practice Address - Phone:970-402-0575
Practice Address - Fax:970-818-9325
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO322171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist