Provider Demographics
NPI:1396855011
Name:MCCOY, JOE W (DC)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:W
Last Name:MCCOY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 HWY 62 SW
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653
Mailing Address - Country:US
Mailing Address - Phone:870-425-1644
Mailing Address - Fax:870-425-2049
Practice Address - Street 1:1634 HWY 62 SW
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653
Practice Address - Country:US
Practice Address - Phone:870-425-1644
Practice Address - Fax:870-425-2049
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR14516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U66960Medicare UPIN
AR5T616Medicare ID - Type Unspecified