Provider Demographics
NPI:1952689101
Name:JAMES E EISENHARDT DC PC
Entity Type:Organization
Organization Name:JAMES E EISENHARDT DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:EISENHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-348-6640
Mailing Address - Street 1:5816 HWY 54
Mailing Address - Street 2:STE 110
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065
Mailing Address - Country:US
Mailing Address - Phone:573-348-6640
Mailing Address - Fax:
Practice Address - Street 1:5816 HWY 54
Practice Address - Street 2:STE 110
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065
Practice Address - Country:US
Practice Address - Phone:573-348-6640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES E EISENHARDT DC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty