Provider Demographics
NPI:1396978482
Name:CHAN, TRACY (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 CURTNER AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-1300
Mailing Address - Country:US
Mailing Address - Phone:408-963-6993
Mailing Address - Fax:408-963-6796
Practice Address - Street 1:2100 CURTNER AVE
Practice Address - Street 2:SUITE G
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-1300
Practice Address - Country:US
Practice Address - Phone:408-963-6993
Practice Address - Fax:408-963-6796
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13102171100000X
CAND-365175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist