Healthcare Provider Details

I. General information

NPI: 1376536060
Provider Name (Legal Business Name): RICHARD EVERETT MCCOY D. C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 09/11/2017
Certification Date:
Deactivation Date: 03/27/2006
Reactivation Date: 04/10/2006

III. Provider practice location address

181 N VIRGINIA ST SUITE 1
CRYSTAL LAKE IL
60014-3433
US

IV. Provider business mailing address

6306 SUTTONDALE RD
HUNTLEY IL
60142-9597
US

V. Phone/Fax

Practice location:
  • Phone: 815-455-6373
  • Fax: 815-455-6375
Mailing address:
  • Phone: 847-669-5380
  • Fax: 847-669-5380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-004127
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: