Provider Demographics
NPI:1497703177
Name:LOCKHART CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:LOCKHART CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-792-2200
Mailing Address - Street 1:103 COUNTRY CLUB DR NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2935
Mailing Address - Country:US
Mailing Address - Phone:704-792-2200
Mailing Address - Fax:704-792-2204
Practice Address - Street 1:103 COUNTRY CLUB DR NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2935
Practice Address - Country:US
Practice Address - Phone:704-792-2200
Practice Address - Fax:704-792-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89013EKMedicaid
NC89013EKMedicaid