MEDICARE: MR. TRACY GLENN HOYT D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0200X	Radiology Chiropractor	DC20071	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	330876706	OTHER	CA	TAX ID
2	DC20071	OTHER	CA	LICENSE NUMBER

General Provider Information

NPI Number	:	1740358266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TRACY GLENN HOYT D.C.

Provider Business Mailing Address
First Line	:	25285 MADISON AVE
Second Line	:	108
City	:	MURRIETA
State	:	CA
Zip	:	92562-8955
Country	:	US
Telephone Number	:	951-600-8198
Fax Number	:	951-698-4932

Provider Business Practice Location Address
First Line	:	25285 MADISON AVE
Second Line	:	108
City	:	MURRIETA
State	:	CA
Zip	:	92562-8955
Country	:	US
Telephone Number	:	951-600-8198
Fax Number	:	951-698-4932

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	07/08/2007

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