Provider Demographics
NPI:1184671331
Name:VAN LAECKEN, TRACY STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:STEVEN
Last Name:VAN LAECKEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15640 N 7TH ST
Mailing Address - Street 2:SUITE #A3
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-3512
Mailing Address - Country:US
Mailing Address - Phone:602-298-1600
Mailing Address - Fax:602-298-6790
Practice Address - Street 1:15640 N 7TH ST
Practice Address - Street 2:SUITE #A3
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-3512
Practice Address - Country:US
Practice Address - Phone:602-298-1600
Practice Address - Fax:602-298-6790
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7703111N00000X
SD1084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor