Provider Demographics
NPI:1245471556
Name:GRANDFIELD, TRACI ANN (DC)
Entity type:Individual
Prefix:DR
First Name:TRACI
Middle Name:ANN
Last Name:GRANDFIELD
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 1:2946 EASTLAKE AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3010
Mailing Address - Country:US
Mailing Address - Phone:206-632-5500
Mailing Address - Fax:206-632-5601
Practice Address - Street 1:2946 EASTLAKE AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3010
Practice Address - Country:US
Practice Address - Phone:206-632-5500
Practice Address - Fax:206-632-5601
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60043009111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor