Provider Demographics
NPI:1538461215
Name:REICHERT, TRACI LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:TRACI
Middle Name:LYNN
Last Name:REICHERT
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 1:7651 E US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7972
Mailing Address - Country:US
Mailing Address - Phone:317-272-7988
Mailing Address - Fax:
Practice Address - Street 1:7651 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7972
Practice Address - Country:US
Practice Address - Phone:317-272-7988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002550A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor