Provider Demographics
NPI:1497031736
Name:TRICOCHE FAMILY CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:TRICOCHE FAMILY CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:TRICOCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS
Authorized Official - Phone:386-562-0188
Mailing Address - Street 1:1710 BRYAN ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4412
Mailing Address - Country:US
Mailing Address - Phone:386-562-0188
Mailing Address - Fax:321-768-8726
Practice Address - Street 1:1710 BRYAN ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4412
Practice Address - Country:US
Practice Address - Phone:386-562-0188
Practice Address - Fax:321-768-8726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty