Healthcare Provider Details

I. General information

NPI: 1750708814
Provider Name (Legal Business Name): URBAN CHIROPRACTIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 YOUNGSTOWN WARREN RD
NILES OH
44446-4564
US

IV. Provider business mailing address

22 YOUNGSTOWN WARREN RD
NILES OH
44446-4564
US

V. Phone/Fax

Practice location:
  • Phone: 330-544-2225
  • Fax: 330-544-0596
Mailing address:
  • Phone: 330-544-2225
  • Fax: 330-544-0596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4294
License Number StateOH

VIII. Authorized Official

Name: DR. JESSICA M ECKMAN
Title or Position: OWNER/CHIROPRACTOR
Credential: D.C.
Phone: 330-544-2225