Provider Demographics
NPI:1568402394
Name:MCINTOSH, LYNN L (DC)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:L
Last Name:MCINTOSH
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 1:3738 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64109-2648
Mailing Address - Country:US
Mailing Address - Phone:816-931-7689
Mailing Address - Fax:816-753-4620
Practice Address - Street 1:4700 BELLEVIEW AVE
Practice Address - Street 2:SUITE L12
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1378
Practice Address - Country:US
Practice Address - Phone:816-753-4600
Practice Address - Fax:816-753-4620
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002030424111NS0005X
KS01-04816111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO32542012OtherBLUE CROSS BLUE SHIELD ID
MO85-0487961OtherTAX ID
MO32542012OtherBLUE CROSS BLUE SHIELD ID
MOP8100000Medicare ID - Type UnspecifiedKANSAS CITY CHIROPRACTIC
MOP81C720Medicare ID - Type UnspecifiedDR. MCINTOSH