Provider Demographics
NPI:1992743959
Name:BALL, TRACY M (DC)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:M
Last Name:BALL
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 1:13079 OLD FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-5612
Mailing Address - Country:US
Mailing Address - Phone:410-480-1852
Mailing Address - Fax:410-480-1857
Practice Address - Street 1:3525 ELLICOTT MILLS DR
Practice Address - Street 2:SUITE F
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4547
Practice Address - Country:US
Practice Address - Phone:410-480-1852
Practice Address - Fax:410-480-1857
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2850436OtherAETNA HMO
MD60621103OtherCAREFIRST
MDF852 0001OtherCAREFIRST
MD123873OtherJOHNS HOPKINS
MD7816145OtherAETNAPPO
MD2100515OtherMAMSI
MD60621103OtherCAREFIRST
MD7816145OtherAETNAPPO