Provider Demographics
NPI:1295241396
Name:LACKEY, ERIKA NICOLE
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:NICOLE
Last Name:LACKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 MYSTIC COVE DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-2961
Mailing Address - Country:US
Mailing Address - Phone:757-651-5922
Mailing Address - Fax:
Practice Address - Street 1:355 CRAWFORD ST STE 105
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2832
Practice Address - Country:US
Practice Address - Phone:757-399-4700
Practice Address - Fax:757-399-0011
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557450111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor