Provider Demographics
NPI:1508158064
Name:EISENMENGER, DAVID JOHN (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:EISENMENGER
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 1:15615 PACIFIC ST
Mailing Address - Street 2:STE 6
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2118
Mailing Address - Country:US
Mailing Address - Phone:913-575-2410
Mailing Address - Fax:
Practice Address - Street 1:11720 BLUE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64134-3718
Practice Address - Country:US
Practice Address - Phone:913-575-2410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor