Provider Demographics
NPI:1669644720
Name:ECKERT PC
Entity Type:Organization
Organization Name:ECKERT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WENDELL
Authorized Official - Last Name:ECKERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMSW
Authorized Official - Phone:989-845-4274
Mailing Address - Street 1:623 S LINE ST
Mailing Address - Street 2:
Mailing Address - City:CHESANING
Mailing Address - State:MI
Mailing Address - Zip Code:48616-1433
Mailing Address - Country:US
Mailing Address - Phone:989-845-4274
Mailing Address - Fax:989-845-4274
Practice Address - Street 1:144 N SAGINAW ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CHESANING
Practice Address - State:MI
Practice Address - Zip Code:48616-1280
Practice Address - Country:US
Practice Address - Phone:989-252-6689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-29
Last Update Date:2008-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801084119251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health