Provider Demographics
NPI:1316266489
Name:TRACY, KILY (DC)
Entity type:Individual
Prefix:
First Name:KILY
Middle Name:
Last Name:TRACY
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 1:90 E TASMAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-1617
Mailing Address - Country:US
Mailing Address - Phone:408-994-6100
Mailing Address - Fax:408-944-6102
Practice Address - Street 1:90 E TASMAN DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-1617
Practice Address - Country:US
Practice Address - Phone:408-994-6100
Practice Address - Fax:408-944-6102
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor