Provider Demographics
NPI:1093873374
Name:TRABUE, TRACEY L (DOCTOR OF CHIROPRACT)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
Last Name:TRABUE
Suffix:
Gender:F
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10613 N HAYDEN RD
Mailing Address - Street 2:STE J107
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-353-8351
Mailing Address - Fax:866-849-8196
Practice Address - Street 1:10613 N HAYDEN RD
Practice Address - Street 2:STE J107
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:480-353-8351
Practice Address - Fax:866-849-8196
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7230111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor