Provider Demographics
NPI:1043498934
Name:ECKERT, KENDALL BRUCE (DR, ND, RCR)
Entity Type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:BRUCE
Last Name:ECKERT
Suffix:
Gender:M
Credentials:DR, ND, RCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 IMPERIAL PALM CT
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-1616
Mailing Address - Country:US
Mailing Address - Phone:727-286-6342
Mailing Address - Fax:727-286-6342
Practice Address - Street 1:4209 IMPERIAL PALM CT
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-1616
Practice Address - Country:US
Practice Address - Phone:727-286-6342
Practice Address - Fax:727-286-6342
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRCR0000000082174400000X
TNND175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No175F00000XOther Service ProvidersNaturopath