Provider Demographics
NPI:1871504118
Name:HOWARD, TRACY L (DC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:HOWARD
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 1:1122 MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:VILONIA
Mailing Address - State:AR
Mailing Address - Zip Code:72173-8902
Mailing Address - Country:US
Mailing Address - Phone:501-796-3106
Mailing Address - Fax:501-796-3206
Practice Address - Street 1:1122 MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:VILONIA
Practice Address - State:AR
Practice Address - Zip Code:72173-8902
Practice Address - Country:US
Practice Address - Phone:501-796-3106
Practice Address - Fax:501-796-3206
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59922OtherBLUE CROSS BLUE SHIELD
ARU30690Medicare UPIN