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General NPI Number Information
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NPI Number | 1003011305
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Entity Type | Organization
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Legal Business Name | KELLY A. MCCOY DC, LLC
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8900 LACKLAND RD
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City | OVERLAND
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State | MO
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Zip | 63114-5407
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Country | US
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Telephone | 314-428-2225
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Fax | 314-428-3819
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Provider Business Mailing Address
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Address Line | 8900 LACKLAND RD
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City | OVERLAND
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State | MO
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Zip | 63114-5407
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Country | US
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Telephone | 314-428-2225
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Fax | 314-428-3819
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Authorized Official
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Title or Position | OWNER
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Name | KELLY ANN MCCOY
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Credential | DC
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Telephone | 314-428-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2005013008
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License Number State | MO
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