Provider Demographics
NPI:1699733360
Name:LOCKLEAR, VICTOR ROSS (DC)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ROSS
Last Name:LOCKLEAR
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 1:428 HYATT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341
Mailing Address - Country:US
Mailing Address - Phone:864-488-1050
Mailing Address - Fax:864-488-2297
Practice Address - Street 1:428 HYATT ST
Practice Address - Street 2:SUITE B
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341
Practice Address - Country:US
Practice Address - Phone:864-488-1050
Practice Address - Fax:864-488-2297
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2547Medicaid
SCU843990281Medicare UPIN
SCU843990281Medicare ID - Type Unspecified