Provider Demographics
NPI:1477614576
Name:ECKLEY, SHAWN J (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:J
Last Name:ECKLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S. GALLATIN RD.
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-4008
Mailing Address - Country:US
Mailing Address - Phone:615-868-3000
Mailing Address - Fax:615-868-0688
Practice Address - Street 1:411 GALLATIN PIKE S
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4008
Practice Address - Country:US
Practice Address - Phone:615-868-3000
Practice Address - Fax:615-868-0688
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3674697Medicare ID - Type Unspecified