Provider Demographics
NPI:1346211752
Name:LOCKHART, PHILIP BRYAN (DC)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:BRYAN
Last Name:LOCKHART
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 1:1641 ASBURY RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-5729
Mailing Address - Country:US
Mailing Address - Phone:563-556-8464
Mailing Address - Fax:563-556-0879
Practice Address - Street 1:1641 ASBURY RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-5729
Practice Address - Country:US
Practice Address - Phone:563-556-8464
Practice Address - Fax:563-556-0879
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0091991Medicaid
T00689Medicare UPIN
IA0091991Medicaid