Provider Demographics
NPI:1740288950
Name:LOCKLIN, SHAUN MATTHEW (DC)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:MATTHEW
Last Name:LOCKLIN
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 1:583 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-2035
Mailing Address - Country:US
Mailing Address - Phone:518-481-6886
Mailing Address - Fax:
Practice Address - Street 1:583 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-2035
Practice Address - Country:US
Practice Address - Phone:518-481-6886
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
NYX009233111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX1C601OtherEMPIRE BC
NYC09233-0OtherNYS WORKERS COMP
NYRA4201Medicare ID - Type Unspecified
NYC09233-0OtherNYS WORKERS COMP