Provider Demographics
NPI:1255493987
Name:LOCKHART, VIRGINIA MOORE
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MOORE
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13814 TOWNE WAY DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-1655
Mailing Address - Country:US
Mailing Address - Phone:281-265-4864
Mailing Address - Fax:
Practice Address - Street 1:13814 TOWNE WAY DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-1655
Practice Address - Country:US
Practice Address - Phone:281-265-4864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4449111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor