Provider Demographics
NPI:1255494191
Name:LOCKE CHIROPRACTIC AND REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:LOCKE CHIROPRACTIC AND REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-237-2041
Mailing Address - Street 1:135 GREENFORD PL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-5744
Mailing Address - Country:US
Mailing Address - Phone:864-237-2041
Mailing Address - Fax:
Practice Address - Street 1:135 GREENFORD PL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5744
Practice Address - Country:US
Practice Address - Phone:864-237-2041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty