Provider Demographics
NPI:1720224504
Name:MCALVANAH, TRACY A (DC)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:A
Last Name:MCALVANAH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1770 CENTURY BLVD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3395
Mailing Address - Country:US
Mailing Address - Phone:404-320-0204
Mailing Address - Fax:404-320-1417
Practice Address - Street 1:1770 CENTURY BLVD NE
Practice Address - Street 2:SUITE A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3395
Practice Address - Country:US
Practice Address - Phone:404-320-0204
Practice Address - Fax:404-320-1417
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-27
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GACHIR007291111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition