Provider Demographics
NPI:1427193895
Name:PARSH, TRACY JO (DC)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:JO
Last Name:PARSH
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 1:331 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LACON
Mailing Address - State:IL
Mailing Address - Zip Code:61540-1209
Mailing Address - Country:US
Mailing Address - Phone:309-246-4305
Mailing Address - Fax:
Practice Address - Street 1:331 5TH ST
Practice Address - Street 2:
Practice Address - City:LACON
Practice Address - State:IL
Practice Address - Zip Code:61540-1209
Practice Address - Country:US
Practice Address - Phone:309-246-4305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38010030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209741Medicare ID - Type Unspecified