Organization
LAGRANGE CHIROPRACTIC PSC
Active
Other names
LaGrange Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
LIDO LEE PETRUCCI DC (DOCTOR)
(502) 222-0000
Entity
Organization
Contact information
Practice address
301 S 1ST ST, LAGRANGE, KY 40031
(502) 222-0000
(502) 222-3488
Mailing address
301 S 1ST ST, LAGRANGE, KY 40031
(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
—
0974279
AETNA
KY
01
—
1140369
PASSPORT
KY
01
—
2438073000
PASSPORT ADVANTAGE
KY
01
—
350048657
RAILROAD MEDICARE
KY
05
—
85036697
—
KY
01
—
9943660003
CIGNA
KY
Enumeration date
03/21/2007
Last updated
08/06/2008
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