Provider Demographics
NPI:1902889256
Name:LOCKENOUR, JOHN D (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:LOCKENOUR
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 1:2634 SPRUCE CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6781
Mailing Address - Country:US
Mailing Address - Phone:386-322-2544
Mailing Address - Fax:
Practice Address - Street 1:5889 S WILLIAMSON BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-7134
Practice Address - Country:US
Practice Address - Phone:386-689-4351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000588A111NX0800X
FL9104111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100165920Medicaid
IN100165920Medicaid
INT34863Medicare UPIN