Provider Demographics
NPI:1588841282
Name:MCGARY, KRISTIN GRAYCE (LAC MAC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:GRAYCE
Last Name:MCGARY
Suffix:
Gender:F
Credentials:LAC MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 N VERDE ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001
Mailing Address - Country:US
Mailing Address - Phone:928-213-4431
Mailing Address - Fax:928-556-3094
Practice Address - Street 1:222 N VERDE ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-213-4431
Practice Address - Fax:928-213-4431
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0226171100000X, 175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175L00000XOther Service ProvidersHomeopath