Provider Demographics
NPI:1649450784
Name:HACKETT, TRACY LYNN (LAC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:HACKETT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4108 BEECHER ST NW
Mailing Address - Street 2:APT 202
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-4937
Mailing Address - Country:US
Mailing Address - Phone:202-651-0884
Mailing Address - Fax:202-248-3690
Practice Address - Street 1:1010 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 280
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-3603
Practice Address - Country:US
Practice Address - Phone:202-651-0884
Practice Address - Fax:202-248-3690
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCAC500088171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist