Provider Demographics
NPI:1467808444
Name:LICTUS, LINDSEY
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:LICTUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244B COLUMBIA AVE.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-3619
Mailing Address - Country:US
Mailing Address - Phone:615-465-8327
Mailing Address - Fax:
Practice Address - Street 1:1244B COLUMBIA AVE.
Practice Address - Street 2:SUITE 210
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3619
Practice Address - Country:US
Practice Address - Phone:615-465-8327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2916111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor