Provider Demographics
NPI:1760224737
Name:LOCKETT, FRED RAYMOND (DC)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:RAYMOND
Last Name:LOCKETT
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 1:306 SUNSET DR STE 100
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2492
Mailing Address - Country:US
Mailing Address - Phone:423-926-8304
Mailing Address - Fax:423-926-5976
Practice Address - Street 1:306 SUNSET DR STE 100
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2492
Practice Address - Country:US
Practice Address - Phone:423-926-8304
Practice Address - Fax:423-926-5976
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty