Provider Demographics
NPI:1538269220
Name:JOHN W ECKMAN III
Entity type:Organization
Organization Name:JOHN W ECKMAN III
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ECKMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:704-983-2177
Mailing Address - Street 1:1738 BADIN RD
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-5306
Mailing Address - Country:US
Mailing Address - Phone:704-983-2177
Mailing Address - Fax:704-983-2212
Practice Address - Street 1:1738 BADIN RD
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-5306
Practice Address - Country:US
Practice Address - Phone:704-983-2177
Practice Address - Fax:704-983-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-23
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC013G2OtherBCBSNC
NC89013G2Medicaid
NC013G2OtherBCBSNC