=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427865070
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNN MALONEY L.AC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2024
-----------------------------------------------------
Last Update Date | 12/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 W. BROADWAY BLDG. 3, STE. J
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65203-3842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-424-6108
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 W. BROADWAY BLDG.3, STE. J
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65203-3842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-424-6108
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 2003027900
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------