=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689921835
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOCK CHIROPRACTIC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2012
-----------------------------------------------------
Last Update Date | 08/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1536 NORIEGA ST STE 202
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94122-4460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-221-7228
-----------------------------------------------------
Fax | 415-661-8199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1536 NORIEGA ST STE 202
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94122-4460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-221-7228
-----------------------------------------------------
Fax | 415-661-8199
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. MICHAEL S LOCK
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 415-221-7228
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 15678
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------