Provider Demographics
NPI:1295815454
Name:MCCOY, STEFANI (DC)
Entity type:Individual
Prefix:
First Name:STEFANI
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N BROOME ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7389
Mailing Address - Country:US
Mailing Address - Phone:704-243-3835
Mailing Address - Fax:704-243-2012
Practice Address - Street 1:1201 N BROOME ST
Practice Address - Street 2:SUITE I
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-7389
Practice Address - Country:US
Practice Address - Phone:704-243-3835
Practice Address - Fax:704-243-2012
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3522111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor