Provider Demographics
NPI:1265821482
Name:DUBBS, TRACEE (DC)
Entity Type:Individual
Prefix:
First Name:TRACEE
Middle Name:
Last Name:DUBBS
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 1:3010 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-1736
Mailing Address - Country:US
Mailing Address - Phone:814-940-8888
Mailing Address - Fax:814-940-8988
Practice Address - Street 1:3010 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-1736
Practice Address - Country:US
Practice Address - Phone:814-940-8888
Practice Address - Fax:814-940-8988
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010957111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102999111Medicaid