Provider Demographics
NPI:1558445031
Name:COY, JEFFREY CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHARLES
Last Name:COY
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 1:3052 NORTHPARK DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345
Mailing Address - Country:US
Mailing Address - Phone:281-359-5333
Mailing Address - Fax:281-361-7687
Practice Address - Street 1:3052 NORTHPARK DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77345
Practice Address - Country:US
Practice Address - Phone:281-359-5333
Practice Address - Fax:281-361-7687
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX4423111N00000X
IN08001063111N00000X
TNDC542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU14195Medicare UPIN
TX601988Medicare ID - Type Unspecified