Provider Demographics
NPI:1720250277
Name:STELL, TRACY DIANE (DC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:DIANE
Last Name:STELL
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 1:1601 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-4040
Mailing Address - Country:US
Mailing Address - Phone:310-643-6569
Mailing Address - Fax:310-643-5776
Practice Address - Street 1:2250 PARK PL
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4908
Practice Address - Country:US
Practice Address - Phone:310-643-6569
Practice Address - Fax:310-643-5776
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor