Provider Demographics
NPI:1821153461
Name:MCCOY, GARY ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALAN
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 1:1103 SEATON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:GREENUP
Mailing Address - State:KY
Mailing Address - Zip Code:41144-1132
Mailing Address - Country:US
Mailing Address - Phone:606-618-9388
Mailing Address - Fax:606-618-9389
Practice Address - Street 1:1103 SEATON AVE STE 1
Practice Address - Street 2:
Practice Address - City:GREENUP
Practice Address - State:KY
Practice Address - Zip Code:41144-1132
Practice Address - Country:US
Practice Address - Phone:606-618-9388
Practice Address - Fax:606-618-9389
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8500130300Medicaid
OH0687761Medicaid
OH0687761Medicaid