=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437402286
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA MARIE ECKMAN D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2012
-----------------------------------------------------
Last Update Date | 03/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 YOUNGSTOWN WARREN RD
-----------------------------------------------------
City | NILES
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44446-4564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-544-2225
-----------------------------------------------------
Fax | 330-544-0596
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 YOUNGSTOWN WARREN RD
-----------------------------------------------------
City | NILES
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44446-4564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-544-2225
-----------------------------------------------------
Fax | 330-544-0596
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4294
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------