Provider Demographics
NPI:1003034430
Name:CAIN, TRACEY KATHERINE (DC)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:KATHERINE
Last Name:CAIN
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 1:14 RONNIES PLZ
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-3552
Mailing Address - Country:US
Mailing Address - Phone:314-737-7677
Mailing Address - Fax:314-843-9186
Practice Address - Street 1:14 RONNIES PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-3552
Practice Address - Country:US
Practice Address - Phone:314-737-7677
Practice Address - Fax:314-843-9186
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999137754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO44-00151OtherUNITED HEALTH CARE PROVID
MO7245095OtherAETNA PROVIDER
MO469330OtherANTHEM PROVIDER
MO128079OtherBCBS PROVIDER
MO430021OtherHEALTHLINK PROVIDER
MO430021OtherHEALTHLINK PROVIDER
MOU79487Medicare UPIN