Provider Demographics
NPI:1902940851
Name:ECKHARDT, LARRY (DC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:ECKHARDT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 CLEAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-2763
Mailing Address - Country:US
Mailing Address - Phone:972-325-4456
Mailing Address - Fax:972-635-5293
Practice Address - Street 1:1514 N GREENVILLE AVE
Practice Address - Street 2:STE 340
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-1202
Practice Address - Country:US
Practice Address - Phone:972-325-4456
Practice Address - Fax:972-635-5293
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U02884Medicare UPIN
TX8F22972Medicare PIN