Provider Demographics
NPI:1679621064
Name:MCCOY, ROBERT GEORGE (DC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:GEORGE
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 1:5124 S WESTERN AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5047
Mailing Address - Country:US
Mailing Address - Phone:605-339-3300
Mailing Address - Fax:605-339-8880
Practice Address - Street 1:5124 S WESTERN AVE
Practice Address - Street 2:STE 1
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5047
Practice Address - Country:US
Practice Address - Phone:605-339-3300
Practice Address - Fax:605-339-8880
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1009111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4996016OtherWELLMARK
SD7601720Medicaid
SDS41531Medicare PIN
U97414Medicare UPIN