Provider Demographics
NPI:1801035761
Name:BLEAHU, TRACEY ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:ANN
Last Name:BLEAHU
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 1:5959 TOPANGA CANYON BLVD
Mailing Address - Street 2:181
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3630
Mailing Address - Country:US
Mailing Address - Phone:818-999-6590
Mailing Address - Fax:818-999-1182
Practice Address - Street 1:5959 TOPANGA CANYON BLVD
Practice Address - Street 2:181
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-3630
Practice Address - Country:US
Practice Address - Phone:818-999-6590
Practice Address - Fax:818-999-1182
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31031111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition