Provider Demographics
NPI:1669607057
Name:DINER, TRACEY (DC)
Entity type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:
Last Name:DINER
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 1:25032 VIA ELEVADO
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2641
Mailing Address - Country:US
Mailing Address - Phone:949-303-9944
Mailing Address - Fax:
Practice Address - Street 1:25032 VIA ELEVADO
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2641
Practice Address - Country:US
Practice Address - Phone:949-303-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21947111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor