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Individual

TRACI N NELSON JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DC

Contact information

Practice address
2377 CUMBERLAND SQUARE DR, BETTENDORF, IA 52722-3251
(563) 359-9541
(563) 344-3914
Mailing address
2377 CUMBERLAND SQUARE DR, BETTENDORF, IA 52722-3251
(563) 359-9541
(563) 344-3914

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
731689454
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1186874
IA
01
48886
WELLMARK
IA
Enumeration date
04/18/2006
Last updated
01/30/2017
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