Provider Demographics
NPI:1922052034
Name:CARPENTER-LABRECQUE, TRACY (DC)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:CARPENTER-LABRECQUE
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 12027
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-0100
Mailing Address - Country:US
Mailing Address - Phone:910-343-1111
Mailing Address - Fax:910-343-8292
Practice Address - Street 1:3825 MARKET STREET
Practice Address - Street 2:SUITE ONE
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1401
Practice Address - Country:US
Practice Address - Phone:910-343-1111
Practice Address - Fax:910-343-8292
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08581OtherBCBS
NC6908581Medicaid
350054583OtherRR MEDICARE
NC08581OtherBCBS