Provider Demographics
NPI:1447897715
Name:MCCOY CORP. A CHIROPRACTIC COMMUNITY
Entity type:Organization
Organization Name:MCCOY CORP. A CHIROPRACTIC COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-588-9640
Mailing Address - Street 1:6050 COMMERCE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2111
Mailing Address - Country:US
Mailing Address - Phone:707-588-9640
Mailing Address - Fax:707-588-9675
Practice Address - Street 1:6050 COMMERCE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2111
Practice Address - Country:US
Practice Address - Phone:707-588-9640
Practice Address - Fax:707-588-9675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty