Provider Demographics
NPI:1235272030
Name:BECK, ROBERT JOSEPH (MADC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:BECK
Suffix:
Gender:M
Credentials:MADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 GAUSE BLVD E
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4235
Mailing Address - Country:US
Mailing Address - Phone:985-643-9332
Mailing Address - Fax:985-643-9285
Practice Address - Street 1:2250 GAUSE BLVD E
Practice Address - Street 2:SUITE 302
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4235
Practice Address - Country:US
Practice Address - Phone:985-643-9332
Practice Address - Fax:985-643-9285
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA828111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2877-AOtherBLUE CROSS PROVIDER NO.
LA5S526Medicare ID - Type UnspecifiedPROVIDER NUMBER
LA2877-AOtherBLUE CROSS PROVIDER NO.