Provider Demographics
NPI:1790872083
Name:LOCKWOOD, REX (DC)
Entity Type:Individual
Prefix:
First Name:REX
Middle Name:
Last Name:LOCKWOOD
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 1:841 SAN BRUNO AVE W
Mailing Address - Street 2:5
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-3443
Mailing Address - Country:US
Mailing Address - Phone:650-952-6477
Mailing Address - Fax:650-952-6303
Practice Address - Street 1:841 SAN BRUNO AVE W
Practice Address - Street 2:5
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-3443
Practice Address - Country:US
Practice Address - Phone:650-952-6477
Practice Address - Fax:650-952-6303
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU25213Medicare UPIN