Dr Mukaia Mitchom Lockett LLC
Chiropractor in O Fallon, IL. Organization (NPI-2).
NPI number1871189340
StatusActive
Last updated in NPPESMar 22, 2021
Details
- NPI
- 1871189340
- Entity type
- Organization (NPI-2)
- Legal business name
- Dr Mukaia Mitchom Lockett LLC
- Organization subpart
- No
- Enumeration date
- Dec 17, 2020
- Certification date
- Mar 22, 2021
- Last updated
- Mar 22, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 111N00000X | Chiropractor | – | – | Yes |
| 363LP2300X | Nurse Practitioner, Primary Care | – | – |
Practice location
2 Eagle Ctr Ste 1O Fallon, IL 62269-1847
Phone 618-606-9119 · Fax 877-781-4222
Mailing address
2 Eagle Ctr Ste 1O Fallon, IL 62269-1847
Phone 618-606-9119 · Fax 877-781-4222
Authorized official
Mukaia Mitchom Lockett
Owner
6186069119
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