Provider Demographics
NPI:1013596048
Name:VALLEY CREEK CHIROPRACTIC
Entity Type:Organization
Organization Name:VALLEY CREEK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-517-9239
Mailing Address - Street 1:210 BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT EDWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68660-4511
Mailing Address - Country:US
Mailing Address - Phone:920-517-9239
Mailing Address - Fax:
Practice Address - Street 1:210 BEAVER ST
Practice Address - Street 2:
Practice Address - City:SAINT EDWARD
Practice Address - State:NE
Practice Address - Zip Code:68660-4511
Practice Address - Country:US
Practice Address - Phone:920-517-9239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty