Provider Demographics
NPI:1053369587
Name:LOCKHART, TODD OWEN (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:OWEN
Last Name:LOCKHART
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 COUNTRY CLUB DR NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2935
Mailing Address - Country:US
Mailing Address - Phone:704-792-2200
Mailing Address - Fax:704-792-2204
Practice Address - Street 1:103 COUNTRY CLUB DR NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2935
Practice Address - Country:US
Practice Address - Phone:704-792-2200
Practice Address - Fax:704-792-2204
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085GFMedicaid
NC2454522Medicare ID - Type Unspecified
NC89085GFMedicaid