Provider Demographics
NPI:1912754318
Name:ECKMAN, TYLER RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:RYAN
Last Name:ECKMAN
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 1:100 SARAH ANN BLVD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-2038
Mailing Address - Country:US
Mailing Address - Phone:636-528-8282
Mailing Address - Fax:
Practice Address - Street 1:100 SARAH ANN BLVD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-2038
Practice Address - Country:US
Practice Address - Phone:636-528-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240115419111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor