Provider Demographics
NPI:1952349086
Name:LOCKE, GREGORY H (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:H
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 1:16 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1546
Mailing Address - Country:US
Mailing Address - Phone:732-222-0816
Mailing Address - Fax:732-222-5285
Practice Address - Street 1:16 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1546
Practice Address - Country:US
Practice Address - Phone:732-222-0816
Practice Address - Fax:732-222-5285
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1893904Medicaid
NJ021884Medicare ID - Type Unspecified
NJ10034Medicare UPIN
NJ5309274Medicare UPIN
NH2928Medicare UPIN
NJ1893904Medicaid
NJ0792396000Medicare UPIN
NJX7Z06Medicare UPIN