Provider Demographics
NPI:1174697981
Name:PRICE, TRACY WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:WAYNE
Last Name:PRICE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6044 FALLING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-2571
Mailing Address - Country:US
Mailing Address - Phone:330-256-6502
Mailing Address - Fax:
Practice Address - Street 1:6044 FALLING BROOK DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-2571
Practice Address - Country:US
Practice Address - Phone:330-256-6502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0756892Medicaid
OH$$$$$$$$$-00OtherOBWC
OH0756892Medicaid
T43551Medicare UPIN