Provider Demographics
NPI:1376671016
Name:MCCOY, RACHAEL LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:LEE
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 1:2717 ASHMUN ST
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-3753
Mailing Address - Country:US
Mailing Address - Phone:906-253-4000
Mailing Address - Fax:
Practice Address - Street 1:2717 ASHMUN ST
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-3753
Practice Address - Country:US
Practice Address - Phone:906-253-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95-0-A7-5006-0OtherBLUE CROSS & BLUE SHIELD
MI95-0-A7-5006-0OtherBLUE CROSS & BLUE SHIELD
MIU87867Medicare UPIN