Provider Demographics
NPI:1992859557
Name:RASMUSSON, TRACI LEONE (DC)
Entity Type:Individual
Prefix:DR
First Name:TRACI
Middle Name:LEONE
Last Name:RASMUSSON
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 1:225 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1856
Mailing Address - Country:US
Mailing Address - Phone:406-542-3327
Mailing Address - Fax:406-728-8467
Practice Address - Street 1:225 HICKORY ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-1856
Practice Address - Country:US
Practice Address - Phone:406-542-3327
Practice Address - Fax:406-728-8467
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT866-ACTIVE111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTP00217129OtherRAILROAD BENEFIT PLAN
MT0000161976Medicaid
MT41821OtherBLUE CROSS
MT0000161976Medicaid