Provider Demographics
NPI:1649646407
Name:LOCKE, MATTHEW RYAN (DC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:RYAN
Last Name:LOCKE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 W DIXON BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-6546
Mailing Address - Country:US
Mailing Address - Phone:704-482-0135
Mailing Address - Fax:704-482-0155
Practice Address - Street 1:145 W DIXON BLVD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6546
Practice Address - Country:US
Practice Address - Phone:704-482-0135
Practice Address - Fax:704-482-0155
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor