Provider Demographics
NPI:1487729612
Name:EISENHARDT, JAMES E (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:EISENHARDT
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 1:5816 HWY 54
Mailing Address - Street 2:STE 110
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3046
Mailing Address - Country:US
Mailing Address - Phone:573-348-6640
Mailing Address - Fax:573-348-1944
Practice Address - Street 1:5816 HWY 54
Practice Address - Street 2:STE 110
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3046
Practice Address - Country:US
Practice Address - Phone:573-348-6640
Practice Address - Fax:573-348-1944
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO31649Medicare ID - Type Unspecified
T83525Medicare UPIN