Provider Demographics
NPI:1689812844
Name:KIERNAN, TRACI A (DC)
Entity Type:Individual
Prefix:DR
First Name:TRACI
Middle Name:A
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:TRACI
Other - Middle Name:A
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:12911 CANTRELL RD
Mailing Address - Street 2:STE 4
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-1701
Mailing Address - Country:US
Mailing Address - Phone:501-224-1224
Mailing Address - Fax:501-224-1230
Practice Address - Street 1:12911 CANTRELL RD
Practice Address - Street 2:STE 4
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-1701
Practice Address - Country:US
Practice Address - Phone:501-224-1224
Practice Address - Fax:501-224-1230
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15628111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5AG03G668Medicare PIN