Provider Demographics
NPI:1285842922
Name:MCCOY CHIROPRACTIC P C
Entity Type:Organization
Organization Name:MCCOY CHIROPRACTIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:914-245-8410
Mailing Address - Street 1:250 E MAIN ST
Mailing Address - Street 2:PO BOX 26
Mailing Address - City:JEFFERSON VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10535-1304
Mailing Address - Country:US
Mailing Address - Phone:914-245-8410
Mailing Address - Fax:914-245-8411
Practice Address - Street 1:250 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535-1304
Practice Address - Country:US
Practice Address - Phone:914-245-8410
Practice Address - Fax:914-245-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXLW951Medicare ID - Type Unspecified