Provider Demographics
NPI:1629108279
Name:MCCOY, NEIL E (DC)
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:E
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:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:BEAN STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37708
Mailing Address - Country:US
Mailing Address - Phone:865-993-0095
Mailing Address - Fax:865-993-0099
Practice Address - Street 1:614 BROADWAY DRIVE
Practice Address - Street 2:
Practice Address - City:BEAN STATION
Practice Address - State:TN
Practice Address - Zip Code:37708
Practice Address - Country:US
Practice Address - Phone:865-993-0095
Practice Address - Fax:865-993-0099
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
3113042OtherBCBS
3970148Medicare UPIN