MEDICARE: DR. TRACI ANN GRANDFIELD 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	111N00000X	Chiropractor	CH60043009	WA

General Provider Information

NPI Number	:	1245471556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACI ANN GRANDFIELD D.C.

Provider Business Mailing Address
First Line	:	2946 EASTLAKE AVE E
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-3010
Country	:	US
Telephone Number	:	206-632-5500
Fax Number	:	206-632-5601

Provider Business Practice Location Address
First Line	:	2946 EASTLAKE AVE E
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-3010
Country	:	US
Telephone Number	:	206-632-5500
Fax Number	:	206-632-5601

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

Provider Enumeration Date	:	03/16/2009
Last Update Date	:	10/23/2014

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