Provider Demographics
NPI:1558608109
Name:LOCKWOOD, KERRI SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:KERRI
Middle Name:SUE
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16526 HUTCHINSON DR
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5802
Mailing Address - Country:US
Mailing Address - Phone:952-447-3395
Mailing Address - Fax:952-447-3396
Practice Address - Street 1:14180 COMMERCE AVE NE
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-1483
Practice Address - Country:US
Practice Address - Phone:952-447-3395
Practice Address - Fax:952-447-3396
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5716OtherDC LICENSE NUMBER