Provider Demographics
NPI:1528033115
Name:MORNINGSTAR, TRACY M (DC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:M
Last Name:MORNINGSTAR
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 1:118 S MICHIGAN AVE
Mailing Address - Street 2:P.O. BOX 911
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307
Mailing Address - Country:US
Mailing Address - Phone:231-796-0533
Mailing Address - Fax:231-796-7322
Practice Address - Street 1:118 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307
Practice Address - Country:US
Practice Address - Phone:231-796-0533
Practice Address - Fax:231-796-7322
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI478785014Medicaid
MI950E410510OtherBCBS
MI0E45004OtherBLUE CARE NETWORK
MI478785014Medicaid
MI0P35690Medicare PIN