Provider Demographics
NPI:1992509806
Name:BLAKLEY, TRACY SCOTT JR (DC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:SCOTT
Last Name:BLAKLEY
Suffix:JR
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3132 MATLOCK RD STE 305
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2922
Mailing Address - Country:US
Mailing Address - Phone:817-290-9444
Mailing Address - Fax:
Practice Address - Street 1:3132 MATLOCK RD STE 305
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2922
Practice Address - Country:US
Practice Address - Phone:817-290-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor