Provider Demographics
NPI:1457309353
Name:LOCKLEAR, JASON LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:LYNN
Last Name:LOCKLEAR
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: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
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2959111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085CGMedicaid
NC350055135OtherRAILROAD MEDICARE
NC085CGOtherBLUE CROSS BLUE SHEILD
NC085CGOtherBLUE CROSS BLUE SHEILD
NCU87042Medicare UPIN