Provider Demographics
NPI:1285614156
Name:SMITH, TRACY (DC)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 W 49TH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6550
Mailing Address - Country:US
Mailing Address - Phone:605-373-9090
Mailing Address - Fax:605-336-0771
Practice Address - Street 1:2200 W 49TH ST #106
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6550
Practice Address - Country:US
Practice Address - Phone:605-373-9090
Practice Address - Fax:605-336-0771
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD651276OtherCHIRO CARE PROVIDER #
SD7601062Medicaid
SDC952OtherDAKOTACARE PROVIDER #
SD1261373OtherARAZ PROVIDER #
SD0040564OtherBC/BS PROVIDER #
SD22880OtherSIOUX VALLEY PROVIDER #
SD2273OtherAVERA PROVIDER #
SD7921272OtherAETNA PROVIDER #
SD651276OtherCHIRO CARE PROVIDER #
SD7601062Medicaid