Provider Demographics
NPI:1992034821
Name:LOCKARD, DAVID (DOM, LAC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LOCKARD
Suffix:
Gender:M
Credentials:DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 240147
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AK
Mailing Address - Zip Code:99824-0147
Mailing Address - Country:US
Mailing Address - Phone:907-364-2965
Mailing Address - Fax:
Practice Address - Street 1:1502 2ND ST #3
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AK
Practice Address - Zip Code:99824
Practice Address - Country:US
Practice Address - Phone:907-364-2965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK26171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist