Provider Demographics
NPI:1245343474
Name:LOCK, MEGAN JENNIFER (DC)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:JENNIFER
Last Name:LOCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1362 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2444
Mailing Address - Country:US
Mailing Address - Phone:636-947-7463
Mailing Address - Fax:636-947-7177
Practice Address - Street 1:1362 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2444
Practice Address - Country:US
Practice Address - Phone:636-947-7463
Practice Address - Fax:636-947-7177
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005025919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205255OtherANTHEM ID
MO739053OtherHEALTHLINK ID
MO7986711OtherAETNA