Provider Demographics
NPI:1811979032
Name:FLESHMAN, TRACIE VIRGINIA (DC)
Entity type:Individual
Prefix:DR
First Name:TRACIE
Middle Name:VIRGINIA
Last Name:FLESHMAN
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 1:11929 MEADOWPARK CT
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-1526
Mailing Address - Country:US
Mailing Address - Phone:314-609-0717
Mailing Address - Fax:
Practice Address - Street 1:11929 MEADOWPARK CT
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-1526
Practice Address - Country:US
Practice Address - Phone:314-609-0717
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004035268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
670886OtherUHC/ACN
MOV04866Medicare UPIN
670886OtherUHC/ACN