Provider Demographics
NPI:1275507303
Name:RYDER, TRACEY ALAYNE (DC)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:ALAYNE
Last Name:RYDER
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 1:4809 132ND ST SE, #C101
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208
Mailing Address - Country:US
Mailing Address - Phone:425-585-0507
Mailing Address - Fax:425-948-7947
Practice Address - Street 1:4809 132ND ST SE, #C101
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208
Practice Address - Country:US
Practice Address - Phone:425-585-0507
Practice Address - Fax:425-948-7947
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH0034253111N00000X
WACH00034253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor