Provider Demographics
NPI:1336132513
Name:MCCOY, MICHELLE M (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:M
Last Name:MCCOY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 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
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX9201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU89435Medicare UPIN