Provider Demographics
NPI:1295817963
Name:RUSH, TRACY LYN (DC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYN
Last Name:RUSH
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 1:10776 GRAYS CORNER
Mailing Address - Street 2:UNIT # 8
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3561
Mailing Address - Country:US
Mailing Address - Phone:410-629-0610
Mailing Address - Fax:410-629-0712
Practice Address - Street 1:10776 GRAYS CORNER
Practice Address - Street 2:UNIT # 8
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3561
Practice Address - Country:US
Practice Address - Phone:410-629-0610
Practice Address - Fax:410-629-0712
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD347M476FMedicare PIN