Provider Demographics
NPI:1336414762
Name:TRACY, CHRISTOPHER ZANE
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ZANE
Last Name:TRACY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44904-9774
Mailing Address - Country:US
Mailing Address - Phone:419-631-0142
Mailing Address - Fax:
Practice Address - Street 1:1833 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:44904-9774
Practice Address - Country:US
Practice Address - Phone:419-631-0142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide