1043343098 NPI number — EICKERT CHIROPRACTIC CLINIC PLLC

Table of content: DR. JENNIFER YEN LUU O.D., M.S. (NPI 1669814430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043343098 NPI number — EICKERT CHIROPRACTIC CLINIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EICKERT CHIROPRACTIC CLINIC PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043343098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
317 HIGHWAY 150 NORTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST UNION
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-422-3323
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
317 HIGHWAY 150 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST UNION
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52175-1450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-422-3323
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EICKERT
Authorized Official First Name:
FREDERICK
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
563-422-3323

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  06821 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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