Provider Demographics
NPI:1508239815
Name:DALTON, TRACEY (DC)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:DALTON
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 1:7121 STEPHANIE LN STE 108
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5324
Mailing Address - Country:US
Mailing Address - Phone:402-843-6152
Mailing Address - Fax:
Practice Address - Street 1:5960 VANDERVOORT DR STE 120
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-7400
Practice Address - Country:US
Practice Address - Phone:402-328-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor