Provider Demographics
NPI:1669527321
Name:ALLEN LOCKRIDGE, MIKA (DC)
Entity type:Individual
Prefix:DR
First Name:MIKA
Middle Name:
Last Name:ALLEN LOCKRIDGE
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 1:107 BRADFORD LN
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-2086
Mailing Address - Country:US
Mailing Address - Phone:816-318-1166
Mailing Address - Fax:816-318-1165
Practice Address - Street 1:107 BRADFORD LN
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2086
Practice Address - Country:US
Practice Address - Phone:816-318-1166
Practice Address - Fax:816-318-1165
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC.3754111NI0900X, 111NN0400X, 111NN1001X, 111NR0200X, 111NR0400X, 111NS0005X, 111NX0100X, 111NX0800X
MO2009030179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0900XChiropractic ProvidersChiropractorInternist
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NX0800XChiropractic ProvidersChiropractorOrthopedic