Provider Demographics
NPI:1649437096
Name:ECK, BRADLEY DAVID (DC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DAVID
Last Name:ECK
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 1:112 S MAIN ST
Mailing Address - Street 2:ST.100
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-3481
Mailing Address - Country:US
Mailing Address - Phone:316-321-2000
Mailing Address - Fax:316-321-1225
Practice Address - Street 1:112 S MAIN ST
Practice Address - Street 2:ST.100
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-3481
Practice Address - Country:US
Practice Address - Phone:316-321-2000
Practice Address - Fax:316-321-1225
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060361Medicare PIN