Provider Demographics
NPI:1114385267
Name:CARTER, TRACY JEAN (LAC)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:JEAN
Last Name:CARTER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:JEAN
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:657 W 23RD ST # 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-2037
Mailing Address - Country:US
Mailing Address - Phone:213-245-3268
Mailing Address - Fax:
Practice Address - Street 1:657 W 23RD ST # 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-2037
Practice Address - Country:US
Practice Address - Phone:213-245-3268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15381171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist