Provider Demographics
NPI:1669511317
Name:TRACHSEL, JOHN ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ERIC
Last Name:TRACHSEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14711 PRINCETON AVE STE 13
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-1470
Mailing Address - Country:US
Mailing Address - Phone:805-523-1354
Mailing Address - Fax:805-523-0597
Practice Address - Street 1:14711 PRINCETON AVE STE 13
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-1470
Practice Address - Country:US
Practice Address - Phone:805-523-1354
Practice Address - Fax:805-523-0597
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24013111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24013Medicare ID - Type Unspecified