Provider Demographics
NPI:1821011446
Name:LOCKE, DARRELL VAUGHN (DC)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:VAUGHN
Last Name:LOCKE
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 1:108 N MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44688-0075
Mailing Address - Country:US
Mailing Address - Phone:330-866-0001
Mailing Address - Fax:330-866-0002
Practice Address - Street 1:108 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:OH
Practice Address - Zip Code:44688-0075
Practice Address - Country:US
Practice Address - Phone:330-866-0001
Practice Address - Fax:330-866-0002
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00321806OtherRAILROAD MEDICARE
OHP00321806OtherRAILROAD MEDICARE