Provider Demographics
NPI:1952323172
Name:SHATTO, TRACY L (DC)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:L
Last Name:SHATTO
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 5296
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-5296
Mailing Address - Country:US
Mailing Address - Phone:970-668-3233
Mailing Address - Fax:970-668-3923
Practice Address - Street 1:842 NORTH SUMMIT BLVD
Practice Address - Street 2:# 13
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-3233
Practice Address - Fax:970-668-3923
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor