Provider Demographics
NPI:1780801613
Name:EICHELBERGER, WILLIAM J (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:EICHELBERGER
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 1:1303 NW 16TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-2264
Mailing Address - Country:US
Mailing Address - Phone:208-452-5353
Mailing Address - Fax:208-452-5353
Practice Address - Street 1:1303 NW 16TH ST STE A
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2264
Practice Address - Country:US
Practice Address - Phone:208-452-5353
Practice Address - Fax:208-452-5353
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA307111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor