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General NPI Number Information
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NPI Number | 1205379831
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Entity Type | Organization
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Legal Business Name | WEST PLAINS FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 11/30/2016
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 5003 US HIGHWAY 160
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City | WEST PLAINS
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State | MO
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Zip | 65775-7665
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Country | US
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Telephone | 417-255-8302
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Fax | 417-255-8389
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Provider Business Mailing Address
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Address Line | 5003 US HIGHWAY 160
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City | WEST PLAINS
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State | MO
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Zip | 65775-7665
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Country | US
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Telephone | 417-255-8302
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Fax | 417-255-8389
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. JACOB CARL ECKMAN
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Credential | D.C., M.S.
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Telephone | 417-255-8302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2015038840
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License Number State | MO
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