Provider Demographics
NPI:1962475723
Name:ECCLES, RON W (DC)
Entity type:Individual
Prefix:DR
First Name:RON
Middle Name:W
Last Name:ECCLES
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 1:5911 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-9054
Mailing Address - Country:US
Mailing Address - Phone:319-752-2112
Mailing Address - Fax:319-753-5933
Practice Address - Street 1:5911 MADISON AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-9054
Practice Address - Country:US
Practice Address - Phone:319-752-2112
Practice Address - Fax:319-753-5933
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA17392Medicare ID - Type Unspecified