Provider Demographics
NPI:1366635989
Name:DEESE & LOCKLEAR CHIROPRACTIC CENTER, PLLC
Entity Type:Organization
Organization Name:DEESE & LOCKLEAR CHIROPRACTIC CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:OXENDINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-521-3093
Mailing Address - Street 1:PO BOX 2219
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-2219
Mailing Address - Country:US
Mailing Address - Phone:910-521-3093
Mailing Address - Fax:910-521-3095
Practice Address - Street 1:812 CANDY PARK RD
Practice Address - Street 2:SUITE 6103
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-9129
Practice Address - Country:US
Practice Address - Phone:910-521-3093
Practice Address - Fax:910-521-3095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950376Medicaid
2454204Medicare PIN