# ADVANCED WELLNESS SPORTS AND SPINE, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992095582
- **Authorized official:** DR. BRETT C. LOCKMAN DO (OWNER)
- **Authorized official phone:** (563) 332-2152

## Contact information

- **Practice address:** 4550 E 53RD ST, SUITE 100, DAVENPORT, IA 52807-3171
- **Practice address phone:** (563) 332-2152
- **Practice address fax:** (563) 332-2153
- **Mailing address:** 4550 E 53RD ST, SUITE 100, DAVENPORT, IA 52807-3171
- **Mailing address phone:** (563) 332-2152
- **Mailing address fax:** (563) 332-2153

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 4156 | IA | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | 4156 | IA | — |
| 2081S0010X | Sports Medicine (Physical Medicine & Rehabilitation) Physician | 4156 | IA | — |

## Other

- **Enumeration date:** 04/15/2011
- **Last updated:** 10/22/2012