Provider Demographics
NPI:1255434650
Name:O'NEAL, TRACY LEE (DC)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LEE
Last Name:O'NEAL
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 1:302 W 40TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4633
Mailing Address - Country:US
Mailing Address - Phone:308-632-8779
Mailing Address - Fax:308-632-7688
Practice Address - Street 1:302 W 40TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4633
Practice Address - Country:US
Practice Address - Phone:308-632-8779
Practice Address - Fax:308-632-7688
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47075044613Medicaid
086098Medicare ID - Type Unspecified
T40199Medicare UPIN