Provider Demographics
NPI:1033136692
Name:COBB, LUCY DIANE (DC)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:DIANE
Last Name:COBB
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-4401
Mailing Address - Country:US
Mailing Address - Phone:816-531-1211
Mailing Address - Fax:816-531-1211
Practice Address - Street 1:1807 W 39TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-4401
Practice Address - Country:US
Practice Address - Phone:816-531-1211
Practice Address - Fax:816-531-1211
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004953111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10755017OtherBCBS
MO10755017OtherBCBS