Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CH60862751 | WA |
N | 111NS0005X | Chiropractic Sports Physician | CH60862751 | WA |
NPI | 1275026924 |
---|---|
Provider Name | Dr. Shelby R Lockhart |
First Address | Lacey, WA 98513-2234 |
Second Address | Lacey, WA 98513-2234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2018 |
Last Update Date | 07/06/2018 |