Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 4186 | CO |
Y | 111N00000X | Chiropractor | A05769 | IA |
NPI | 1003186453 |
---|---|
Provider Name | Dr. Tracy Lynn Kirschner |
First Address | Boulder, CO 80304-1537 |
Second Address | Fairfield, IA 52556-3305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2012 |
Last Update Date | 03/01/2012 |