Provider Demographics
NPI:1407229941
Name:ACTIVE CHIROPRACTIC & ACUPUNCTURE, LLC
Entity Type:Organization
Organization Name:ACTIVE CHIROPRACTIC & ACUPUNCTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/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:417-280-2015
Mailing Address - Street 1:4 CEMETERY LANE
Mailing Address - Street 2:
Mailing Address - City:THAYER
Mailing Address - State:MO
Mailing Address - Zip Code:65791
Mailing Address - Country:US
Mailing Address - Phone:417-280-2015
Mailing Address - Fax:
Practice Address - Street 1:4 CEMETERY LANE
Practice Address - Street 2:
Practice Address - City:THAYER
Practice Address - State:MO
Practice Address - Zip Code:65791
Practice Address - Country:US
Practice Address - Phone:417-280-2015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015038840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty