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General NPI Number Information
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NPI Number | 1063422863
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Entity Type | Individual
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Provider Name | TRACY JASON VEDDER D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 11/10/2008
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Provider Practice Location Address
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Address Line | 510 CASTILLO ST SUITE 104
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City | SANTA BARBARA
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State | CA
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Zip | 93101-3406
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Country | US
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Telephone | 805-453-4158
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Fax | 805-568-1680
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Provider Business Mailing Address
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Address Line | 510 CASTILLO ST SUITE 104
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City | SANTA BARBARA
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State | CA
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Zip | 93101-3406
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Country | US
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Telephone | 805-453-4158
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Fax | 805-568-1680
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC23606
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License Number State | CA
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