Provider Demographics
NPI:1376536060
Name:MCCOY, RICHARD EVERETT (D C)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EVERETT
Last Name:MCCOY
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6306 SUTTONDALE RD
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9597
Mailing Address - Country:US
Mailing Address - Phone:847-669-5380
Mailing Address - Fax:847-669-5380
Practice Address - Street 1:181 N VIRGINIA ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3433
Practice Address - Country:US
Practice Address - Phone:815-455-6373
Practice Address - Fax:815-455-6375
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2017-09-11
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-10
Provider Licenses
StateLicense IDTaxonomies
IL038-004127111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05682020-52OtherBLUE CROSS BLUE SHIELD
IL761760Medicare PIN
ILP38686Medicare UPIN