1467590331 NPI number — LOCKHART CHIROPRACTIC, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467590331 NPI number — LOCKHART CHIROPRACTIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOCKHART CHIROPRACTIC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467590331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 792
Provider Second Line Business Mailing Address:
754 S ODELL
Provider Business Mailing Address City Name:
MARSHALL
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65340-0792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-886-7134
Provider Business Mailing Address Fax Number:
660-886-7135

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
754 S ODELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARSHALL
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65340-2504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-886-7134
Provider Business Practice Location Address Fax Number:
660-886-7135
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOCKHART
Authorized Official First Name:
MARK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DOCTOR OF CHIROPRACTIC
Authorized Official Telephone Number:
660-815-0448

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5819 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 16493023 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00307602 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 227259 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 830065090 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500077364 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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