Provider Demographics
NPI:1881764181
Name:LOCKWOOD, STUART J (DC)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:J
Last Name:LOCKWOOD
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 1:714 S GREEN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-3906
Mailing Address - Country:US
Mailing Address - Phone:270-826-3182
Mailing Address - Fax:270-826-0941
Practice Address - Street 1:714 S GREEN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-3906
Practice Address - Country:US
Practice Address - Phone:270-826-3182
Practice Address - Fax:270-826-0941
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYT54249Medicare UPIN