Provider Demographics
NPI:1639378615
Name:TACTI, LUNDY G (DC)
Entity Type:Individual
Prefix:MR
First Name:LUNDY
Middle Name:G
Last Name:TACTI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:LUNDY
Other - Middle Name:G
Other - Last Name:TACTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:9550 BAYMEADOWS ROAD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-730-5115
Mailing Address - Fax:904-828-5550
Practice Address - Street 1:9550 BAYMEADOWS ROAD
Practice Address - Street 2:SUITE 9
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-730-5115
Practice Address - Fax:904-828-5550
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor