Provider Demographics
NPI:1831106962
Name:MCCOY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:MCCOY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATTIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:O'MALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-895-5111
Mailing Address - Street 1:2676 DEKALB AVENUE
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3110
Mailing Address - Country:US
Mailing Address - Phone:815-895-5111
Mailing Address - Fax:815-895-5114
Practice Address - Street 1:2676 DEKALB AVENUE
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3110
Practice Address - Country:US
Practice Address - Phone:815-895-5111
Practice Address - Fax:815-895-5114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060-000586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01915170OtherBCBS PROVIDER ID
ILL0754OtherRAILROAD MEDICARE
IL=========OtherEIN
ILL0754OtherRAILROAD MEDICARE