Advanced Wellness Sports and Spine, PC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

4156 Issued in IA

Legal business name

ADVANCED WELLNESS SPORTS AND SPINE, PC

Practice address

4550 E 53Rd St
Suite 100
Davenport, IA 52807-3171

Phone

(563) 332-2152

Fax

(563) 332-2153

NPI assigned

Apr 15, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Brett C. Lockman, DO

Title

Owner

Phone

(563) 332-2152

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1302825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350864000000",
    "number": "1992095582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4550 E 53RD ST",
            "address_2": "SUITE 100",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073171",
            "telephone_number": "563-332-2152",
            "fax_number": "563-332-2153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4550 E 53RD ST",
            "address_2": "SUITE 100",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073171",
            "telephone_number": "563-332-2152",
            "fax_number": "563-332-2153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED WELLNESS SPORTS AND SPINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-15",
        "last_updated": "2012-10-22",
        "status": "A",
        "authorized_official_last_name": "LOCKMAN",
        "authorized_official_first_name": "BRETT",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "563-332-2152",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IA",
            "license": "4156",
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "IA",
            "license": "4156",
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "IA",
            "license": "4156",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura C Adamson, M.A. CCC-SLP
• Madison Claire Adank, FNP-BC
• Olayinka A. Adedayo, M.D.
• Aina Nyenma Adekunle, M.D.
• Advanced Pain Control Center, PC
• Aeon Group HST
• Aeon Sleep Group
• Affluence Care LLC
• Nancy J Agnew, ARNP
• Ama Asantewaa Agyabeng, PHARMD

• Physical Medicine & Rehabilitation Physician in Davenport, IA
• Providers in Davenport, IA by specialty
• Physical Medicine & Rehabilitation Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.