Provider Demographics
NPI:1932305562
Name:SHRABLE, TRACY DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:DEAN
Last Name:SHRABLE
Suffix:
Gender:M
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 1251
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98812-1251
Mailing Address - Country:US
Mailing Address - Phone:509-689-2225
Mailing Address - Fax:509-689-2225
Practice Address - Street 1:343 MAIN STREET.
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:WA
Practice Address - Zip Code:98812-1251
Practice Address - Country:US
Practice Address - Phone:509-689-2225
Practice Address - Fax:509-689-2225
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA44657OtherDEPT. OF LABOR AND INDUST
WA2017671Medicaid
WA000304849Medicare ID - Type Unspecified
WA2017671Medicaid