Healthcare Provider Details

I. General information

NPI: 1255494191
Provider Name (Legal Business Name): LOCKE CHIROPRACTIC AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 RYMCO DR STE 105
WINSTON SALEM NC
27103-2947
US

IV. Provider business mailing address

1495 RYMCO DR STE 105
WINSTON SALEM NC
27103-2947
US

V. Phone/Fax

Practice location:
  • Phone: 336-937-0442
  • Fax: 336-390-3770
Mailing address:
  • Phone: 336-937-0442
  • Fax: 336-390-3770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3457
License Number StateNC

VIII. Authorized Official

Name: DR. JONATHAN GEORGE LOCKE
Title or Position: CEO
Credential:
Phone: 336-409-9343