Provider Demographics
NPI:1194705582
Name:MCCOY, BRUCE (DC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:MCCOY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 S STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-5703
Mailing Address - Country:US
Mailing Address - Phone:954-978-6466
Mailing Address - Fax:954-973-4590
Practice Address - Street 1:318 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33068-5703
Practice Address - Country:US
Practice Address - Phone:954-978-6466
Practice Address - Fax:954-973-4590
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3505111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU51172Medicare UPIN
FL55174Medicare ID - Type Unspecified