Provider Demographics
NPI:1285657882
Name:DILLY, TRACY MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:MARIE
Last Name:DILLY
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 1:16278 141ST AVE
Mailing Address - Street 2:
Mailing Address - City:OSAKIS
Mailing Address - State:MN
Mailing Address - Zip Code:56360-4575
Mailing Address - Country:US
Mailing Address - Phone:952-240-3564
Mailing Address - Fax:
Practice Address - Street 1:857 MAIN ST S
Practice Address - Street 2:
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56378-1646
Practice Address - Country:US
Practice Address - Phone:320-352-5227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor