Provider Demographics
NPI:1114996790
Name:BARNES, TRACY A (DC)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:A
Last Name:BARNES
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 1:108 ONE HALF CANNONS LN.
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206
Mailing Address - Country:US
Mailing Address - Phone:502-894-8222
Mailing Address - Fax:502-894-8474
Practice Address - Street 1:108 ONE HALF CANNONS LN.
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206
Practice Address - Country:US
Practice Address - Phone:502-894-8222
Practice Address - Fax:502-894-8474
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0000000754456OtherANTHEM
KYU62326Medicare UPIN
KY0000000754456OtherANTHEM