Provider Demographics
NPI:1548994940
Name:SHERLOCK, LORI BETH (LAC, DIPLOM)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:BETH
Last Name:SHERLOCK
Suffix:
Gender:F
Credentials:LAC, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6155 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1957
Mailing Address - Country:US
Mailing Address - Phone:317-255-3030
Mailing Address - Fax:317-255-3030
Practice Address - Street 1:6155 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1957
Practice Address - Country:US
Practice Address - Phone:317-255-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000228A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist