Provider Demographics
NPI:1326367269
Name:VISLOCKY, VICTORIA J (DC)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:J
Last Name:VISLOCKY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 SW PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5017
Mailing Address - Country:US
Mailing Address - Phone:772-621-7777
Mailing Address - Fax:772-335-4912
Practice Address - Street 1:149 SW PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5017
Practice Address - Country:US
Practice Address - Phone:772-621-7777
Practice Address - Fax:772-335-4912
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor