MEDICARE: DR. DERRICK BENNET EICHSTADT D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2002010021	MO

General Provider Information

NPI Number	:	1144225640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DERRICK BENNET EICHSTADT D.C.

Provider Business Mailing Address
First Line	:	503 W HIGHWAY 54
Second Line	:
City	:	HERMITAGE
State	:	MO
Zip	:	65668-9105
Country	:	US
Telephone Number	:	417-745-6152
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 W HIGHWAY 54
Second Line	:
City	:	HERMITAGE
State	:	MO
Zip	:	65668-9105
Country	:	US
Telephone Number	:	417-745-6152
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/08/2007

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