Individual
DR. THERESA LUCITO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
13925 52ND AVE N APT 1102, PLYMOUTH, MN 55446-1645
(763) 772-5260
Mailing address
13925 52ND AVE N APT 1102, PLYMOUTH, MN 55446-1645
(763) 772-5260
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5159
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942451190
—
MN
Enumeration date
10/07/2008
Last updated
03/16/2021
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