=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104076470
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ECKMAN CHIROPRACTIC CLINIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2008
-----------------------------------------------------
Last Update Date | 09/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 WHITNEY ST SUITE A
-----------------------------------------------------
City | DOWAGIAC
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49047-1672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-782-1144
-----------------------------------------------------
Fax | 269-782-1145
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 WHITNEY ST SUITE A
-----------------------------------------------------
City | DOWAGIAC
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49047-1672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-782-1144
-----------------------------------------------------
Fax | 269-782-1145
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JAMES ROBERT ECKMAN JR.
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 269-782-1144
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2301008329
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------