Healthcare Provider Details

I. General information

NPI: 1639403744
Provider Name (Legal Business Name): STEPHANIE F MCGUIRK MSOM, DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD MAILSTOP 1017
KANSAS CITY KS
66103-2937
US

IV. Provider business mailing address

4617 W 90TH ST
PRAIRIE VILLAGE KS
66207-2304
US

V. Phone/Fax

Practice location:
  • Phone: 913-945-6743
  • Fax: 913-588-0012
Mailing address:
  • Phone: 913-522-1198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberDA00238
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: