Provider Demographics
NPI:1912005448
Name:ECKERSON, DAVID DONALD (DC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DONALD
Last Name:ECKERSON
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 1:4464 MCGRATH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7764
Mailing Address - Country:US
Mailing Address - Phone:805-278-6767
Mailing Address - Fax:805-278-8282
Practice Address - Street 1:4464 MCGRATH ST STE 105
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7764
Practice Address - Country:US
Practice Address - Phone:805-278-6767
Practice Address - Fax:805-278-8282
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0191070OtherBLUE CROSS/BLUE SHIELD #
CAU30320Medicare UPIN
CADC19107AMedicare ID - Type Unspecified2ND OFFICE, FILLMORE
CADC19107Medicare ID - Type Unspecified