Provider Demographics
NPI:1336330844
Name:LOCKHART CHIROPRACTIC OF ST. CHARLES
Entity Type:Organization
Organization Name:LOCKHART CHIROPRACTIC OF ST. CHARLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ELERY
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-946-3722
Mailing Address - Street 1:925 1ST CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2733
Mailing Address - Country:US
Mailing Address - Phone:636-946-3722
Mailing Address - Fax:636-949-5095
Practice Address - Street 1:925 1ST CAPITOL DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2733
Practice Address - Country:US
Practice Address - Phone:636-946-3722
Practice Address - Fax:636-949-5095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006743261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========OtherBLUE CROSS & BLUE SHIELD