Provider Demographics
NPI:1023287059
Name:MCCARTY, DIANE C (MSOM, LAC)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:C
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1503 NEWCASTLE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4834
Mailing Address - Country:US
Mailing Address - Phone:719-640-8857
Mailing Address - Fax:719-264-1795
Practice Address - Street 1:3030 N HANCOCK AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5761
Practice Address - Country:US
Practice Address - Phone:719-640-8857
Practice Address - Fax:719-264-1795
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-24
Last Update Date:2008-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO587171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist