Provider Demographics
NPI:1689988321
Name:REGAN, TRACEY (DC)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:
Last Name:REGAN
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 1:4910 E RAY RD
Mailing Address - Street 2:#G9
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6419
Mailing Address - Country:US
Mailing Address - Phone:480-893-8000
Mailing Address - Fax:
Practice Address - Street 1:4910 E RAY RD
Practice Address - Street 2:#G9
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6419
Practice Address - Country:US
Practice Address - Phone:480-893-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor