Individual
TRACY GLEN BAGWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
2227 DRAKE AVENUE, SUITE 13, HUNTSVILLE, AL 35805
(256) 880-8833
(256) 880-8838
Mailing address
2227 DRAKE AVENUE, SUITE 13, HUNTSVILLE, AL 35805
(256) 880-8833
(256) 880-8838
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
AL1224
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71286
BLUE CROSS BLUE SHIELD
AL
Enumeration date
07/03/2006
Last updated
07/08/2007
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