Provider Demographics
NPI:1922130038
Name:PHAM, TRACY TIEN (DC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:TIEN
Last Name:PHAM
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 1:5634 SUMMER SNOW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-5528
Mailing Address - Country:US
Mailing Address - Phone:281-804-5540
Mailing Address - Fax:713-988-8511
Practice Address - Street 1:8880 BELLAIRE BLVD
Practice Address - Street 2:#A1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4628
Practice Address - Country:US
Practice Address - Phone:713-988-9797
Practice Address - Fax:713-988-8511
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8008111N00000X, 111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician