Provider Demographics
NPI:1477746600
Name:ECKES, PATRICK RAYMOND (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:RAYMOND
Last Name:ECKES
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:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:GRASS LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49240-0141
Mailing Address - Country:US
Mailing Address - Phone:517-522-8315
Mailing Address - Fax:517-522-5493
Practice Address - Street 1:125 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:GRASS LAKE
Practice Address - State:MI
Practice Address - Zip Code:49240-9188
Practice Address - Country:US
Practice Address - Phone:517-522-8315
Practice Address - Fax:517-522-5493
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005921111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950 C 811540OtherBLUE CROSS BLUE SHIELD
MI950 C 811540OtherBLUE CROSS BLUE SHIELD