Provider Demographics
NPI:1831231349
Name:MCCOY, KRISTIAN FREDERICK (DC)
Entity type:Individual
Prefix:MR
First Name:KRISTIAN
Middle Name:FREDERICK
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 1:9 BOSTON STREET
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-2536
Mailing Address - Country:US
Mailing Address - Phone:781-592-8089
Mailing Address - Fax:781-592-8091
Practice Address - Street 1:9 BOSTON STREET
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-2536
Practice Address - Country:US
Practice Address - Phone:781-592-8089
Practice Address - Fax:781-592-8091
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH1982111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1606824Medicaid
MAAA28215OtherHARRARD PILGRIM
MAY36415OtherBC BS OF MA
MC Y45360Medicare ID - Type Unspecified