Provider Demographics
NPI:1750708814
Name:URBAN CHIROPRACTIC CLINIC INC
Entity type:Organization
Organization Name:URBAN CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-544-2225
Mailing Address - Street 1:22 YOUNGSTOWN WARREN RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-4564
Mailing Address - Country:US
Mailing Address - Phone:330-544-2225
Mailing Address - Fax:330-544-0596
Practice Address - Street 1:22 YOUNGSTOWN WARREN RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4564
Practice Address - Country:US
Practice Address - Phone:330-544-2225
Practice Address - Fax:330-544-0596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1437402286OtherINDIVIDUAL NPI