Provider Demographics
NPI:1881104453
Name:COY CHIROPRACTIC INSTITUTE, INC.
Entity type:Organization
Organization Name:COY CHIROPRACTIC INSTITUTE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:B
Authorized Official - Last Name:DEXTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-528-1113
Mailing Address - Street 1:7444 FLORENCE AVE STE H
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3600
Mailing Address - Country:US
Mailing Address - Phone:563-528-1113
Mailing Address - Fax:
Practice Address - Street 1:7444 FLORENCE AVE STE H
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3600
Practice Address - Country:US
Practice Address - Phone:563-528-1113
Practice Address - Fax:562-776-1745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34042111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty