Provider Demographics
NPI:1801971866
Name:TRUDEL, TRACY A (DC)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:A
Last Name:TRUDEL
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 1:9 FINNEY BLVD
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1038
Mailing Address - Country:US
Mailing Address - Phone:518-483-2804
Mailing Address - Fax:518-483-2872
Practice Address - Street 1:9 FINNEY BLVD
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1038
Practice Address - Country:US
Practice Address - Phone:518-483-2804
Practice Address - Fax:518-483-2872
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX96621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U79437Medicare UPIN
CC7506Medicare ID - Type Unspecified