Provider Demographics
NPI:1750336616
Name:RESTIERI LUCAS, TRACIE LYNN (DC)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:LYNN
Last Name:RESTIERI LUCAS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18467 NW US HIGHWAY 441 STE 80
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-8795
Mailing Address - Country:US
Mailing Address - Phone:201-956-3772
Mailing Address - Fax:
Practice Address - Street 1:18467 NW US HIGHWAY 441 STE 80
Practice Address - Street 2:
Practice Address - City:HIGH SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32643-8795
Practice Address - Country:US
Practice Address - Phone:201-956-3772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00640900111N00000X
FLCH10855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHG654ZOtherPTAN