1912098344 NPI number — DR. JUDY L MCCOY DC

Table of content: DR. JUDY L MCCOY DC (NPI 1912098344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912098344 NPI number — DR. JUDY L MCCOY DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCOY
Provider First Name:
JUDY
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCOY MCVEY
Provider Other First Name:
JUDY
Provider Other Middle Name:
LAFAYETTE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1912098344
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1904 PACIFIC AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98201-4413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-339-1277
Provider Business Mailing Address Fax Number:
425-252-6827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1904 PACIFIC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98201-4413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-339-1277
Provider Business Practice Location Address Fax Number:
425-252-6827
Provider Enumeration Date:
09/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00003022 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 2976 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)