Provider Demographics
NPI:1174948491
Name:LOCKHART, JESSICA ANNE
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANNE
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6377 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1429
Mailing Address - Country:US
Mailing Address - Phone:419-764-9232
Mailing Address - Fax:
Practice Address - Street 1:6525 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-4855
Practice Address - Country:US
Practice Address - Phone:216-573-2600
Practice Address - Fax:216-573-1933
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4427111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor