Provider Demographics
NPI:1669798450
Name:ECKERT, CLARK RAYMOND (DC)
Entity type:Individual
Prefix:
First Name:CLARK
Middle Name:RAYMOND
Last Name:ECKERT
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 1:1062 OAK RIDGE TPKE STE B
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6479
Mailing Address - Country:US
Mailing Address - Phone:865-220-8499
Mailing Address - Fax:865-272-3356
Practice Address - Street 1:1062 OAK RIDGE TPKE STE B
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6479
Practice Address - Country:US
Practice Address - Phone:865-220-8499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2431111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor