Healthcare Provider Details

I. General information

NPI: 1003034430
Provider Name (Legal Business Name): TRACEY KATHERINE CAIN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 RONNIES PLZ
SAINT LOUIS MO
63126-3552
US

IV. Provider business mailing address

14 RONNIES PLZ
SAINT LOUIS MO
63126-3552
US

V. Phone/Fax

Practice location:
  • Phone: 314-737-7677
  • Fax: 314-843-9186
Mailing address:
  • Phone: 314-737-7677
  • Fax: 314-843-9186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1999137754
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: