Provider Demographics
NPI:1841291119
Name:TRACY, MONYA MATTHIESEN (DC)
Entity type:Individual
Prefix:DR
First Name:MONYA
Middle Name:MATTHIESEN
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 1:800 W HIGHWAY 290
Mailing Address - Street 2:BLDG F, STE 500
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-4191
Mailing Address - Country:US
Mailing Address - Phone:512-858-9355
Mailing Address - Fax:
Practice Address - Street 1:800 W HIGHWAY 290
Practice Address - Street 2:BLDG F, STE 500
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-4191
Practice Address - Country:US
Practice Address - Phone:512-858-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor