Provider Demographics
NPI:1114184835
Name:SOBEL, TRACEY PAMELA (DIPLOM, LAC)
Entity Type:Individual
Prefix:MISS
First Name:TRACEY
Middle Name:PAMELA
Last Name:SOBEL
Suffix:
Gender:F
Credentials:DIPLOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4111
Mailing Address - Country:US
Mailing Address - Phone:303-859-1889
Mailing Address - Fax:
Practice Address - Street 1:2516 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4111
Practice Address - Country:US
Practice Address - Phone:303-859-1889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2516171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist