Healthcare Provider Details

I. General information

NPI: 1205829512
Provider Name (Legal Business Name): ALICE M TRAUTMAN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8484 SW 103RD STREET RD
OCALA FL
34481-7766
US

IV. Provider business mailing address

5895 SW 52ND ST
OCALA FL
34474-5664
US

V. Phone/Fax

Practice location:
  • Phone: 352-854-1112
  • Fax: 352-237-0946
Mailing address:
  • Phone: 352-237-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0005053
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number609
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1937
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3750
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4892
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: