Organization
ADVANCED WELLNESS SPORTS AND SPINE, PC
Active
Organization
ADVANCED WELLNESS SPORTS AND SPINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRETT C. LOCKMAN DO (OWNER)
(563) 332-2152
Entity
Organization
Contact information
Practice address
4550 E 53RD ST, SUITE 100, DAVENPORT, IA 52807-3171
(563) 332-2152
(563) 332-2153
Mailing address
4550 E 53RD ST, SUITE 100, DAVENPORT, IA 52807-3171
(563) 332-2152
(563) 332-2153
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
4156
IA
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
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