Kenneth Le Roy Eckhardt, D.C.

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

19439 Issued in CA

Practice address

7100 Redwood Blvd
Suite 102
Novato, CA 94945-4110

Phone

(415) 892-2212

Fax

(415) 892-9458

NPI assigned

Oct 18, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379462400000",
    "number": "1255412151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 ROWLAND BLVD",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949474617",
            "telephone_number": "415-892-2212",
            "fax_number": "415-892-9458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7100 REDWOOD BLVD",
            "address_2": "SUITE 102",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949454110",
            "telephone_number": "415-892-2212",
            "fax_number": "415-892-9458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ECKHARDT",
        "first_name": "KENNETH",
        "middle_name": "LE ROY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2013-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "CA",
            "license": "19439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Physician Chiropractor in Novato, CA
• Providers in Novato, CA by specialty
• Sports Physician Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.