Provider Demographics
NPI:1609910025
Name:KECMAN, BOBAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BOBAN
Middle Name:
Last Name:KECMAN
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 1:116 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-4049
Mailing Address - Country:US
Mailing Address - Phone:219-662-8797
Mailing Address - Fax:
Practice Address - Street 1:116 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4049
Practice Address - Country:US
Practice Address - Phone:219-662-8797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001931A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28617OtherBENEFIT SYSTEMS AND SERVI
IN28617OtherISTA INSURANCE TRUST
IN90001124OtherBC BS OF ILLINOIS
IN7494190OtherAETNA
IN5466849OtherCCN DCA
IN28617OtherINDIANA HEALTH NETWORK
IN000000203846OtherANTHEM BC BS
IN7494190OtherAETNA
IN5466849OtherCCN DCA