MEDICARE: SUE MCCOMB L.AC., DIPL.AC., LMT

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	171100000X	Acupuncturist	2002024899	MO

General Provider Information

NPI Number	:	1922125129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE MCCOMB L.AC., DIPL.AC., LMT

Provider Business Mailing Address
First Line	:	1209 W 37TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3878
Country	:	US
Telephone Number	:	816-931-3131
Fax Number	:	816-753-4326

Provider Business Practice Location Address
First Line	:	1209 W 37TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3878
Country	:	US
Telephone Number	:	816-931-3131
Fax Number	:	816-753-4326

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	08/21/2007

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