Individual
TRACY LYNN PREVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
15050 SW KOLL PKWY, BEAVERTON, OR 97006-6001
(503) 439-9494
Mailing address
15050 SW KOLL PKWY, BEAVERTON, OR 97006
(503) 439-9494
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3244
OR
Other
Enumeration date
10/18/2012
Last updated
10/18/2012
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