Provider Demographics
NPI:1942832258
Name:STILL, TRACY YVONNE (DC)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:YVONNE
Last Name:STILL
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 1:3905 NE GRAND AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-1168
Mailing Address - Country:US
Mailing Address - Phone:910-619-8083
Mailing Address - Fax:
Practice Address - Street 1:3905B NE GRAND AVE UNIT B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-1107
Practice Address - Country:US
Practice Address - Phone:910-619-8083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor