Provider Demographics
NPI:1568759959
Name:MCMAHON, ANAH (LAC)
Entity Type:Individual
Prefix:
First Name:ANAH
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:48W879 PLANK ROAD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IL
Practice Address - Zip Code:60109
Practice Address - Country:US
Practice Address - Phone:773-494-0771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000619171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist