Provider Demographics
NPI:1578537528
Name:LUCIDO, DAVID PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
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:863-284-5870
Mailing Address - Fax:863-248-2643
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:2006-02-15
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381505600Medicaid
FL381505600Medicaid
FL55182ZMedicare ID - Type Unspecified