Active Chiropractic & Acupuncture, LLC
Organization Active NPI Chiropractor · Thayer, MO
NPI 1407229941 · NPPES record last updated Nov 5, 2015
Key facts
- NPI
- 1407229941
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2015038840 (MO)
- Legal business name
- ACTIVE CHIROPRACTIC & ACUPUNCTURE, LLC
- Practice address
- 4 Cemetery Lane
Thayer, MO 65791 - Phone
- (417) 280-2015
- NPI assigned
- Nov 5, 2015
- Organization subpart
- No
Authorized official
- Name
- Dr. Jacob Carl Eckman, D.C., M.S.
- Title
- Owner/Chiropractic Physician
- Phone
- (417) 280-2015
Practitioners 1
-
Jacob Carl Eckman, D.C., M.S.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160815001020 | MO | Part B Supplier - Clinic/Group Practice | 0840584827 |
Receives reassigned benefits from 1 practitioner Practice locations: Thayer, MO; West Plains, MO |
National Provider Directory
Locations
4 Cemetery Ln
Thayer, MO 65791
Phone (417) 280-2015
5003 US Highway 160
West Plains, MO 65775
Phone (417) 255-8302
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 2015038840 | MO | Yes |
Addresses
Primary practice location
4 Cemetery Lane
Thayer, MO 65791
Mailing address
4 Cemetery Lane
Thayer, MO 65791
Phone (417) 280-2015
Other providers in Thayer, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 5, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.