Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH0001443 | FL |
NPI | 1003929019 |
---|---|
Provider Name | Dr. Vincent P. Lucido |
First Address | Lakeland, FL 33803-3415 |
Second Address | Lakeland, FL 33803-3415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/07/2007 |