Provider Demographics
NPI:1972936607
Name:LOCKWOOD CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:LOCKWOOD CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-962-6015
Mailing Address - Street 1:113 W LOCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2915
Mailing Address - Country:US
Mailing Address - Phone:314-962-6015
Mailing Address - Fax:
Practice Address - Street 1:113 W LOCKWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2915
Practice Address - Country:US
Practice Address - Phone:314-962-6015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013000984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty