Provider Demographics
NPI:1225021595
Name:LOCKWOOD, MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:LOCKWOOD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12951 BEL RED RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2628
Mailing Address - Country:US
Mailing Address - Phone:425-455-3636
Mailing Address - Fax:425-455-2910
Practice Address - Street 1:12951 BEL RED RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2644
Practice Address - Country:US
Practice Address - Phone:425-455-3636
Practice Address - Fax:425-455-2910
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 0000 2783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG000120454Medicare PIN
WAU42067Medicare UPIN