Healthcare Provider Details

I. General information

NPI: 1982924734
Provider Name (Legal Business Name): LINDELOCK CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 GRAHAM RD SUITE C
ITHACA NY
14850-1141
US

IV. Provider business mailing address

179 GRAHAM RD SUITE C
ITHACA NY
14850-1141
US

V. Phone/Fax

Practice location:
  • Phone: 607-319-4734
  • Fax: 607-319-4708
Mailing address:
  • Phone: 607-319-4734
  • Fax: 607-319-4708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX011855
License Number StateNY

VIII. Authorized Official

Name: DR. REBECCA MARIE MATLOCK
Title or Position: CO OWNER
Credential: DC
Phone: 908-619-7845