Provider Demographics
NPI:1104850387
Name:ECKMAN, CONNIE (DC)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:
Last Name:ECKMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:DESANDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1738 BADIN RD
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-5306
Mailing Address - Country:US
Mailing Address - Phone:704-983-2177
Mailing Address - Fax:704-983-2212
Practice Address - Street 1:1738 BADIN RD
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-5306
Practice Address - Country:US
Practice Address - Phone:704-983-2177
Practice Address - Fax:704-983-2212
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00228432OtherRAILROAD MEDICARE
NC085G3OtherBLUE CROSS/BLUE SHIELD
NC89085G3Medicaid
NCP00228432OtherRAILROAD MEDICARE
NC89085G3Medicaid