Provider Demographics
NPI:1205379831
Name:WEST PLAINS FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:WEST PLAINS FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:ECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS
Authorized Official - Phone:417-255-8302
Mailing Address - Street 1:5003 US HIGHWAY 160
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-7665
Mailing Address - Country:US
Mailing Address - Phone:417-255-8302
Mailing Address - Fax:417-255-8389
Practice Address - Street 1:5003 US HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-7665
Practice Address - Country:US
Practice Address - Phone:417-255-8302
Practice Address - Fax:417-255-8389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015038840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty