Provider Demographics
NPI:1215372982
Name:BECKER, LARRY ADAM (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ADAM
Last Name:BECKER
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210339
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-0339
Mailing Address - Country:US
Mailing Address - Phone:415-752-4476
Mailing Address - Fax:
Practice Address - Street 1:875 42ND AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-3324
Practice Address - Country:US
Practice Address - Phone:415-752-4476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 14477171100000X
CADC 20053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist