Provider Demographics
NPI:1093798381
Name:WADDINGTON, TRACY LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LYNN
Last Name:WADDINGTON
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 1:2085 N 120TH ST STE D10
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3480
Mailing Address - Country:US
Mailing Address - Phone:402-397-3339
Mailing Address - Fax:402-399-9271
Practice Address - Street 1:2085 N 120TH ST STE D10
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3480
Practice Address - Country:US
Practice Address - Phone:402-397-3339
Practice Address - Fax:402-399-9271
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE91184385200Medicaid
NE350039494OtherPALMETTO GBA
269248Medicare ID - Type Unspecified
NE91184385200Medicaid
1093798381Medicare Oscar/Certification
NE350039494OtherPALMETTO GBA