Provider Demographics
NPI:1992586333
Name:LOCKHART CHIROPRACTIC
Entity type:Organization
Organization Name:LOCKHART CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:262-657-8434
Mailing Address - Street 1:5024 GREEN BAY ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1702
Mailing Address - Country:US
Mailing Address - Phone:262-657-8434
Mailing Address - Fax:262-657-8435
Practice Address - Street 1:5024 GREEN BAY ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1702
Practice Address - Country:US
Practice Address - Phone:262-657-8434
Practice Address - Fax:262-657-8435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty