Healthcare Provider Details

I. General information

NPI: 1972526663
Provider Name (Legal Business Name): KELLY A MCCOY GROSS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8999 SAINT CHARLES ROCK RD
SAINT LOUIS MO
63114-4260
US

IV. Provider business mailing address

8999 SAINT CHARLES ROCK RD
SAINT LOUIS MO
63114-4260
US

V. Phone/Fax

Practice location:
  • Phone: 314-428-2225
  • Fax: 314-428-3338
Mailing address:
  • Phone: 314-428-2225
  • Fax: 314-428-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2005013008
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: