Provider Demographics
NPI:1548408842
Name:JOHN D LOCKENOUR D C INC
Entity Type:Organization
Organization Name:JOHN D LOCKENOUR D C INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOCKENOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-689-4351
Mailing Address - Street 1:2634 SPRUCE CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6781
Mailing Address - Country:US
Mailing Address - Phone:386-689-4351
Mailing Address - Fax:
Practice Address - Street 1:5889 S WILLIAMSON BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-7134
Practice Address - Country:US
Practice Address - Phone:386-689-4351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9104261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center