Provider Demographics
NPI:1932183738
Name:MCCUAN, KATHY A (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:A
Last Name:MCCUAN
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 1:7379 HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-7105
Mailing Address - Country:US
Mailing Address - Phone:573-388-1546
Mailing Address - Fax:573-388-1546
Practice Address - Street 1:7379 HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-7105
Practice Address - Country:US
Practice Address - Phone:573-388-1546
Practice Address - Fax:573-388-1546
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T43460Medicare UPIN
31015Medicare ID - Type Unspecified