Provider Demographics
NPI:1487156295
Name:LOCKWOOD CHIROPRACTIC CLINIC, PLLC
Entity type:Organization
Organization Name:LOCKWOOD CHIROPRACTIC CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-682-5010
Mailing Address - Street 1:2030 CASS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:KEEGO HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48320-1235
Mailing Address - Country:US
Mailing Address - Phone:248-682-5010
Mailing Address - Fax:
Practice Address - Street 1:2030 CASS LAKE RD
Practice Address - Street 2:
Practice Address - City:KEEGO HARBOR
Practice Address - State:MI
Practice Address - Zip Code:48320-1235
Practice Address - Country:US
Practice Address - Phone:248-682-5010
Practice Address - Fax:248-682-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty