Provider Demographics
NPI:1629199476
Name:LACY, PEYTON THOM (DC)
Entity Type:Individual
Prefix:DR
First Name:PEYTON
Middle Name:THOM
Last Name:LACY
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 1:3008 BOCA CIEGA DR N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-2834
Mailing Address - Country:US
Mailing Address - Phone:727-430-5790
Mailing Address - Fax:
Practice Address - Street 1:3008 BOCA CIEGA DR N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-2834
Practice Address - Country:US
Practice Address - Phone:727-430-5790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor