Healthcare Provider Details

I. General information

NPI: 1558433714
Provider Name (Legal Business Name): TRACY LYNN MAGIE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 GRAND AVE #C
SAN MARCOS CA
92078-2424
US

IV. Provider business mailing address

PO BOX 1176
CARDIFF CA
92007-7176
US

V. Phone/Fax

Practice location:
  • Phone: 760-752-1551
  • Fax: 760-436-3993
Mailing address:
  • Phone: 858-509-7999
  • Fax: 858-509-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC17993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: