Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 19439 | CA |
NPI | 1255412151 |
---|---|
Provider Name | Dr. Kenneth Le Roy Eckhardt |
First Address | Novato, CA 94947-4617 |
Second Address | Novato, CA 94945-4110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 18/09/2013 |