MEDICARE: DR. TRACIE VIRGINIA FLESHMAN 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	2004035268	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	670886	OTHER		UHC/ACN

General Provider Information

NPI Number	:	1811979032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACIE VIRGINIA FLESHMAN D.C.

Provider Business Mailing Address
First Line	:	11929 MEADOWPARK CT
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-1526
Country	:	US
Telephone Number	:	314-609-0717
Fax Number	:

Provider Business Practice Location Address
First Line	:	11929 MEADOWPARK CT
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-1526
Country	:	US
Telephone Number	:	314-609-0717
Fax Number	:

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	07/08/2007

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