Provider Demographics
NPI:1760482343
Name:LACKEY, TIMOTHY SCOTT (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:SCOTT
Last Name:LACKEY
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 1:30 W SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-5428
Mailing Address - Country:US
Mailing Address - Phone:620-663-5632
Mailing Address - Fax:620-663-4986
Practice Address - Street 1:30 W SHERMAN ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-5428
Practice Address - Country:US
Practice Address - Phone:620-663-5632
Practice Address - Fax:620-663-4986
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060008OtherBCBS
KS060008OtherBCBS
U60950Medicare UPIN