Provider Demographics
NPI:1003929019
Name:LUCIDO, VINCENT P (DC)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:P
Last Name:LUCIDO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1965 E EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-3415
Mailing Address - Country:US
Mailing Address - Phone:863-683-8006
Mailing Address - Fax:863-683-8225
Practice Address - Street 1:1965 E EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3415
Practice Address - Country:US
Practice Address - Phone:863-683-8006
Practice Address - Fax:863-683-8225
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0001443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor