Provider Demographics
NPI:1821425158
Name:LUCCE, SALLY BRAIDS (DC)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:BRAIDS
Last Name:LUCCE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SALLY
Other - Middle Name:LEE
Other - Last Name:BRAIDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:153 WARD ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-1112
Mailing Address - Country:US
Mailing Address - Phone:860-938-2642
Mailing Address - Fax:
Practice Address - Street 1:153 WARD ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-1112
Practice Address - Country:US
Practice Address - Phone:860-938-2642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor