Provider Demographics
NPI:1891939112
Name:FOWLER, TRACIE KAY (DC)
Entity Type:Individual
Prefix:DR
First Name:TRACIE
Middle Name:KAY
Last Name:FOWLER
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 1:437 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2324
Mailing Address - Country:US
Mailing Address - Phone:651-388-8113
Mailing Address - Fax:651-388-8114
Practice Address - Street 1:437 MAIN ST
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2324
Practice Address - Country:US
Practice Address - Phone:651-388-8113
Practice Address - Fax:651-388-8114
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4499111N00000X
MN4442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor