Provider Demographics
NPI:1811909534
Name:MCCOY, MARK J (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
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 1:1119 SW GAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1999
Mailing Address - Country:US
Mailing Address - Phone:785-272-3878
Mailing Address - Fax:785-272-7117
Practice Address - Street 1:1119 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1999
Practice Address - Country:US
Practice Address - Phone:785-272-3878
Practice Address - Fax:785-272-7117
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS007291OtherBCBS ID NUMBER
KST43944Medicare UPIN
KS007291Medicare ID - Type UnspecifiedMEDICARE ID NUMBER