MEDICARE: DR. RICHARD C COY DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	005331	MO
2	111N00000X	Chiropractor		IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	215809	OTHER	IL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	44-01024	OTHER	IL	UNITED HEALTH CARE
3	7422	OTHER	MO	ALLIANCE BLUE CROSS
4	47722	OTHER	IL	CMR
5	180267	OTHER	IL	HEALTHLINK
6	47722	OTHER	IL	GHP
7	6082091	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1053315663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD C COY DC

Provider Business Mailing Address
First Line	:	3407 S STATE ROUTE 157
Second Line	:	STE 1
City	:	GLEN CARBON
State	:	IL
Zip	:	62034-1041
Country	:	US
Telephone Number	:	618-288-3610
Fax Number	:	618-288-9879

Provider Business Practice Location Address
First Line	:	3407 S STATE ROUTE 157
Second Line	:	STE 1
City	:	GLEN CARBON
State	:	IL
Zip	:	62034-1041
Country	:	US
Telephone Number	:	618-288-3610
Fax Number	:	618-288-9879

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	12/17/2007

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Directions to “ DR. RICHARD C COY DC” Practice Location

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