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General NPI Number Information
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NPI Number | 1407229941
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Entity Type | Organization
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Legal Business Name | ACTIVE CHIROPRACTIC & ACUPUNCTURE, LLC
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 4 CEMETERY LANE
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City | THAYER
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State | MO
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Zip | 65791
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Country | US
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Telephone | 417-280-2015
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Fax |
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Provider Business Mailing Address
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Address Line | 4 CEMETERY LANE
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City | THAYER
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State | MO
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Zip | 65791
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Country | US
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Telephone | 417-280-2015
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Fax |
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Authorized Official
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Title or Position | OWNER/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 | 417-280-2015
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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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