Provider Demographics
NPI:1912098344
Name:MCCOY, JUDY L (DC)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:L
Last Name:MCCOY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JUDY
Other - Middle Name:LAFAYETTE
Other - Last Name:MCCOY MCVEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1904 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4413
Mailing Address - Country:US
Mailing Address - Phone:425-339-1277
Mailing Address - Fax:425-252-6827
Practice Address - Street 1:1904 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4413
Practice Address - Country:US
Practice Address - Phone:425-339-1277
Practice Address - Fax:425-252-6827
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003022111N00000X
OR2976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U52787Medicare UPIN