Provider Demographics
NPI:1437211695
Name:MCINTYRE, TRACEY LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:LYNN
Last Name:MCINTYRE
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 1:1819 BROADWAY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5670
Mailing Address - Country:US
Mailing Address - Phone:281-993-9333
Mailing Address - Fax:
Practice Address - Street 1:1819 BROADWAY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5670
Practice Address - Country:US
Practice Address - Phone:281-993-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV06266Medicare UPIN
TX8F0860Medicare ID - Type Unspecified