Provider Demographics
NPI:1992836845
Name:ECKDAHL, ERIC L (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:L
Last Name:ECKDAHL
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:PO BOX 1967
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-1967
Mailing Address - Country:US
Mailing Address - Phone:970-926-9222
Mailing Address - Fax:970-926-9223
Practice Address - Street 1:34295 US HWY 6
Practice Address - Street 2:UNIT C-6
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-1967
Practice Address - Country:US
Practice Address - Phone:970-926-9222
Practice Address - Fax:970-926-9223
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3992171100000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3992OtherCOLO STATE LICENSE ECKDAH
COC801891Medicare PIN