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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