Provider Demographics
NPI:1265692909
Name:ECKERT CHIROPRACTIC CENTER P.C.
Entity type:Organization
Organization Name:ECKERT CHIROPRACTIC CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:ECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-322-2057
Mailing Address - Street 1:1298A W FOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-8303
Mailing Address - Country:US
Mailing Address - Phone:816-322-2057
Mailing Address - Fax:816-322-3156
Practice Address - Street 1:1298A W FOXWOOD DR
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-8303
Practice Address - Country:US
Practice Address - Phone:816-322-2057
Practice Address - Fax:816-322-3156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5051111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT73845Medicare UPIN