Provider Demographics
NPI:1144758244
Name:LOCKE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:LOCKE CHIROPRACTIC, LLC
Other - Org Name:REGENERATE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-398-0182
Mailing Address - Street 1:11920 HIGHWAY 707 STE A4
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-9609
Mailing Address - Country:US
Mailing Address - Phone:864-398-0182
Mailing Address - Fax:
Practice Address - Street 1:11920 HIGHWAY 707 STE A4
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-9609
Practice Address - Country:US
Practice Address - Phone:864-398-0182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty