Provider Demographics
NPI:1902021959
Name:TRAYLOR, SONDRA LEE (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:SONDRA
Middle Name:LEE
Last Name:TRAYLOR
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23115 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-8960
Mailing Address - Country:US
Mailing Address - Phone:952-474-5289
Mailing Address - Fax:
Practice Address - Street 1:23115 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-8960
Practice Address - Country:US
Practice Address - Phone:952-474-5289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1486171100000X
MN2298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist