MEDICARE: TRACIE LYNN RESTIERI LUCAS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	38MC00640900	NJ
2	111N00000X	Chiropractor	CH10855	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HG654Z	OTHER	FL	PTAN

General Provider Information

NPI Number	:	1750336616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACIE LYNN RESTIERI LUCAS D.C.

Provider Business Mailing Address
First Line	:	18467 NW US HIGHWAY 441 STE 80
Second Line	:
City	:	HIGH SPRINGS
State	:	FL
Zip	:	32643-8795
Country	:	US
Telephone Number	:	201-956-3772
Fax Number	:

Provider Business Practice Location Address
First Line	:	18467 NW US HIGHWAY 441 STE 80
Second Line	:
City	:	HIGH SPRINGS
State	:	FL
Zip	:	32643-8795
Country	:	US
Telephone Number	:	201-956-3772
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	07/18/2023

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