Healthcare Provider Details

I. General information

NPI: 1275539819
Provider Name (Legal Business Name): CHARLES LESLIE ECKERT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1296B W FOXWOOD DR
RAYMORE MO
64083-8300
US

IV. Provider business mailing address

1298A W FOXWOOD DR
RAYMORE MO
64083-8303
US

V. Phone/Fax

Practice location:
  • Phone: 816-322-2057
  • Fax: 816-322-3156
Mailing address:
  • Phone: 816-322-2057
  • Fax: 816-322-3156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5051
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number5051
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: