Healthcare Provider Details

I. General information

NPI: 1962837757
Provider Name (Legal Business Name): JOSHUA EUGENE LOCKROW D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15545 W 87TH ST
LENEXA KS
66219-1434
US

IV. Provider business mailing address

8733 NOLAND RD
LENEXA KS
66215-3433
US

V. Phone/Fax

Practice location:
  • Phone: 913-894-4428
  • Fax:
Mailing address:
  • Phone: 913-968-7218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number01-05578
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: