Provider Demographics
NPI:1720111347
Name:LOCKHART CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:LOCKHART CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-798-3237
Mailing Address - Street 1:88 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1700
Mailing Address - Country:US
Mailing Address - Phone:518-798-3237
Mailing Address - Fax:518-798-3238
Practice Address - Street 1:88 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1700
Practice Address - Country:US
Practice Address - Phone:518-798-3237
Practice Address - Fax:518-798-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004875-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID NUMBER
NY53485BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NY=========OtherTAX ID NUMBER