Provider Demographics
NPI:1922680966
Name:TRACEY, MADELEINE (DAC)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:TRACEY
Suffix:
Gender:F
Credentials:DAC
Other - Prefix:
Other - First Name:MADDIE
Other - Middle Name:
Other - Last Name:TRACEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DAC
Mailing Address - Street 1:225 W HUBBARD ST STE 302
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:710 DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-3228
Practice Address - Country:US
Practice Address - Phone:312-216-2452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001555171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist