Provider Demographics
NPI:1982924734
Name:LINDELOCK CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:LINDELOCK CHIROPRACTIC PLLC
Other - Org Name:CENTERSTONE CHIROPRACTIC AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MATLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-619-7845
Mailing Address - Street 1:179 GRAHAM RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1141
Mailing Address - Country:US
Mailing Address - Phone:607-319-4734
Mailing Address - Fax:607-319-4708
Practice Address - Street 1:179 GRAHAM RD
Practice Address - Street 2:SUITE C
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1141
Practice Address - Country:US
Practice Address - Phone:607-319-4734
Practice Address - Fax:607-319-4708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty