Provider Demographics
NPI:1275874380
Name:LOCKE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:LOCKE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-351-9792
Mailing Address - Street 1:19767 SW 72ND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8354
Mailing Address - Country:US
Mailing Address - Phone:503-620-6480
Mailing Address - Fax:503-684-4598
Practice Address - Street 1:19767 SW 72ND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8354
Practice Address - Country:US
Practice Address - Phone:503-620-6480
Practice Address - Fax:503-684-4598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5005111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR162599Medicare PIN