Provider Demographics
NPI:1801099262
Name:BUCKINGHAM, TRACEY LYNNE (DC)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNNE
Last Name:BUCKINGHAM
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 1:108 NEWBOLD ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-3906
Mailing Address - Country:US
Mailing Address - Phone:704-735-8226
Mailing Address - Fax:704-735-8280
Practice Address - Street 1:8656 BROOK GLEN LN
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-2743
Practice Address - Country:US
Practice Address - Phone:714-390-2432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3472111N00000X
CA28368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor