Healthcare Provider Details

I. General information

NPI: 1821272154
Provider Name (Legal Business Name): LOCKE CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N. MAIN ST.
WAYNESBURG OH
44688-0075
US

IV. Provider business mailing address

PO BOX 75
WAYNESBURG OH
44688-0075
US

V. Phone/Fax

Practice location:
  • Phone: 330-866-0001
  • Fax: 330-866-0002
Mailing address:
  • Phone: 330-866-0001
  • Fax: 330-866-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number135
License Number StateOH

VIII. Authorized Official

Name: DR. DARRELL VAUGHN LOCKE
Title or Position: OWNER
Credential: DC
Phone: 330-866-0001