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General NPI Number Information
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NPI Number | 1982924734
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Entity Type | Organization
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Legal Business Name | LINDELOCK CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 06/03/2010
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Provider Practice Location Address
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Address Line | 179 GRAHAM RD SUITE C
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City | ITHACA
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State | NY
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Zip | 14850-1141
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Country | US
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Telephone | 607-319-4734
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Fax | 607-319-4708
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Provider Business Mailing Address
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Address Line | 179 GRAHAM RD SUITE C
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City | ITHACA
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State | NY
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Zip | 14850-1141
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Country | US
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Telephone | 607-319-4734
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Fax | 607-319-4708
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Authorized Official
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Title or Position | CO OWNER
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Name | DR. REBECCA MARIE MATLOCK
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Credential | DC
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Telephone | 908-619-7845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X011855
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License Number State | NY
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