Provider Demographics
NPI:1215068440
Name:EDWARDS CHIROPRACTIC AND ACUPUNCTURE CENTER LLC
Entity type:Organization
Organization Name:EDWARDS CHIROPRACTIC AND ACUPUNCTURE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:L
Authorized Official - Last Name:ECKDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-926-9222
Mailing Address - Street 1:PO BOX 1967
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-1967
Mailing Address - Country:US
Mailing Address - Phone:970-926-9222
Mailing Address - Fax:970-926-9223
Practice Address - Street 1:34295 U.S. HWY 6
Practice Address - Street 2:UNIT C-6
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-1967
Practice Address - Country:US
Practice Address - Phone:970-926-9222
Practice Address - Fax:970-926-9223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3992111N00000X, 171100000X
CO4073111N00000X
CO686171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC801980Medicare PIN