Provider Demographics
NPI:1518007376
Name:ECK, DOUGLAS J
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:J
Last Name:ECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:KS
Mailing Address - Zip Code:67420-3214
Mailing Address - Country:US
Mailing Address - Phone:785-738-2304
Mailing Address - Fax:
Practice Address - Street 1:405 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:KS
Practice Address - Zip Code:67420-3214
Practice Address - Country:US
Practice Address - Phone:785-738-2304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS00100159471Medicaid