MEDICARE: DR. THOMAS ANDREW LOCKE DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NX0800X	Orthopedic Chiropractor	038004342	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01617190	OTHER	IL	BC/BS PIN

General Provider Information

NPI Number	:	1255375739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS ANDREW LOCKE DC

Provider Business Mailing Address
First Line	:	1539 LEE ST
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-1518
Country	:	US
Telephone Number	:	847-298-0606
Fax Number	:	847-298-0617

Provider Business Practice Location Address
First Line	:	1539 LEE ST
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-1518
Country	:	US
Telephone Number	:	847-298-0606
Fax Number	:	847-298-0617

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	02/10/2009

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