Provider Demographics
NPI:1558433714
Name:MAGIE, TRACY LYNN (DC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:MAGIE
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:PO BOX 1176
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-7176
Mailing Address - Country:US
Mailing Address - Phone:858-509-7999
Mailing Address - Fax:858-509-3993
Practice Address - Street 1:1537 GRAND AVE
Practice Address - Street 2:#C
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2424
Practice Address - Country:US
Practice Address - Phone:760-752-1551
Practice Address - Fax:760-436-3993
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT91380Medicare UPIN