Provider Demographics
NPI:1730282328
Name:LOCKHART, RANDALL SCOTT (DC)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:SCOTT
Last Name:LOCKHART
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 1:19 HOMER AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804
Mailing Address - Country:US
Mailing Address - Phone:518-798-3237
Mailing Address - Fax:518-743-8686
Practice Address - Street 1:19 HOMER AVE
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804
Practice Address - Country:US
Practice Address - Phone:518-798-3237
Practice Address - Fax:518-743-8686
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0048751111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53485AMedicare ID - Type Unspecified