Healthcare Provider Details

I. General information

NPI: 1740370964
Provider Name (Legal Business Name): TROY CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SARAH ANN BLVD
TROY MO
63379-2038
US

IV. Provider business mailing address

100 SARAH ANN BLVD
TROY MO
63379-2038
US

V. Phone/Fax

Practice location:
  • Phone: 636-528-8282
  • Fax: 636-528-3914
Mailing address:
  • Phone: 636-528-8282
  • Fax: 636-528-3914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2002002939
License Number StateMO

VIII. Authorized Official

Name: DR. RYAN D ECKMAN
Title or Position: OWNER
Credential: DC
Phone: 636-528-8282