Provider Demographics
NPI:1760482301
Name:EICKERT, FREDERICK WALTER (DC)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:WALTER
Last Name:EICKERT
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 1:723 12TH AVE S
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-6315
Mailing Address - Country:US
Mailing Address - Phone:563-242-1099
Mailing Address - Fax:563-242-1099
Practice Address - Street 1:723 12TH AVE S
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-6315
Practice Address - Country:US
Practice Address - Phone:563-242-1099
Practice Address - Fax:563-242-1099
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor