Provider Demographics
NPI:1801821269
Name:TRACY, DIANE (DC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:TRACY
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:PO BOX 1396
Mailing Address - Street 2:
Mailing Address - City:HOOPA
Mailing Address - State:CA
Mailing Address - Zip Code:95546-1396
Mailing Address - Country:US
Mailing Address - Phone:530-625-5470
Mailing Address - Fax:
Practice Address - Street 1:HWY 96
Practice Address - Street 2:BOX 1396
Practice Address - City:HOOPA
Practice Address - State:CA
Practice Address - Zip Code:95546-1396
Practice Address - Country:US
Practice Address - Phone:530-625-5470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor