Provider Demographics
NPI:1699956409
Name:DEESE & LOCKLEAR CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:DEESE & LOCKLEAR CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-521-3093
Mailing Address - Street 1:812 CANDY PARK RD STE 6103
Mailing Address - Street 2:PO BOX 2219
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-9129
Mailing Address - Country:US
Mailing Address - Phone:910-521-3093
Mailing Address - Fax:910-521-3095
Practice Address - Street 1:812 CANDY PARK RD STE 6103
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-9129
Practice Address - Country:US
Practice Address - Phone:910-521-3093
Practice Address - Fax:910-521-3095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2454204Medicare PIN