Provider Demographics
NPI:1588725212
Name:MCCOMBS, STEPHEN LEE (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEE
Last Name:MCCOMBS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-3091
Mailing Address - Country:US
Mailing Address - Phone:952-846-4149
Mailing Address - Fax:952-846-4234
Practice Address - Street 1:2550 HORIZON DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-3091
Practice Address - Country:US
Practice Address - Phone:952-846-4149
Practice Address - Fax:952-846-4234
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN649097OtherGREAT WEST
MN71-0920535OtherPREFERRED PROVIDER ORGANIZATION
MN71-0920535OtherMAYO MANAGEMENT SERVICES INC.
MN649097OtherUNITED HEALTH CARE
MNCC1034AOtherPATIENT CHOICE
MN349J8MCOtherBCBS
MN71-0920535OtherHSM
MNCC1034AOtherHEALTH PARTNERS
MNCC1034AOtherCIGNA
MN71-0920535OtherWEA TRUST
MN71-0920535OtherPREFERRED ONE
MN71-0920535OtherAETNA
MNCC1034AOtherUCARE OF MINNESOTA
MN649097OtherMEDICA
MN71-0920535OtherBENEFIT PLAN ADMINISTRATORS
MN71-0920535OtherPRO NET
MN71-0920535OtherBENEFIT PLAN ADMINISTRATORS