Individual
DR. LIDO L PETRUCCI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
301 S 1ST ST, LAGRANGE, KY 40031-1240
(502) 222-0000
(502) 222-3488
Mailing address
301 S 1ST ST, LAGRANGE, KY 40031-1240
(502) 222-0000
(502) 222-3488
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4315
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000051634
ANTHEM
KY
01
—
0974279
AETNA
KY
01
—
1140365
PASSPORT
KY
01
—
2438072000
PASSPORT ADVANTAGE
KY
01
—
350048657
RAILROAD MEDICARE
KY
05
—
85036697
—
KY
01
—
9943660003
CIGNA
KY
Enumeration date
09/12/2006
Last updated
11/26/2007
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