Provider Demographics
NPI:1063499622
Name:DRENNEN-ALEXANDER, TRACEY LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:LYNN
Last Name:DRENNEN-ALEXANDER
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 1:1002 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:FREEBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62243-4008
Mailing Address - Country:US
Mailing Address - Phone:618-539-3333
Mailing Address - Fax:618-539-2222
Practice Address - Street 1:1002 N STATE ST
Practice Address - Street 2:
Practice Address - City:FREEBURG
Practice Address - State:IL
Practice Address - Zip Code:62243-4008
Practice Address - Country:US
Practice Address - Phone:618-539-3333
Practice Address - Fax:618-539-2222
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-26
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009402111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL473545OtherHEALTHLINK
IL1030171OtherCIGNA
MO157115OtherBC/BS OF MO
IL8232017OtherBC/BS OF IL
ILP00081255Medicare ID - Type UnspecifiedRR MEDICARE
IL200346Medicare ID - Type Unspecified