Provider Demographics
NPI:1720201700
Name:TRAFECANTY, THOMAS BRENT (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BRENT
Last Name:TRAFECANTY
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:PO BOX 881701
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92168-1701
Mailing Address - Country:US
Mailing Address - Phone:619-296-2225
Mailing Address - Fax:619-296-2242
Practice Address - Street 1:2333 CAMINO DEL RIO S STE 230
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3600
Practice Address - Country:US
Practice Address - Phone:619-296-2225
Practice Address - Fax:619-296-2242
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor