Healthcare Provider Details

I. General information

NPI: 1568402394
Provider Name (Legal Business Name): LYNN L MCINTOSH D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 BELLEVIEW AVE SUITE L12
KANSAS CITY MO
64112-1378
US

IV. Provider business mailing address

3738 HARRISON ST
KANSAS CITY MO
64109-2648
US

V. Phone/Fax

Practice location:
  • Phone: 816-753-4600
  • Fax: 816-753-4620
Mailing address:
  • Phone: 816-931-7689
  • Fax: 816-753-4620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2002030424
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number01-04816
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: