Provider Demographics
NPI:1043679699
Name:BECKER, CHAD WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:WILLIAM
Last Name:BECKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10497 NW 108TH PL
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IA
Mailing Address - Zip Code:50109-9797
Mailing Address - Country:US
Mailing Address - Phone:435-513-2004
Mailing Address - Fax:
Practice Address - Street 1:1200 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1406
Practice Address - Country:US
Practice Address - Phone:515-241-6412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-05356207P00000X
CA123456207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty