Provider Demographics
NPI:1265448203
Name:BECK, RICHARD WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WAYNE
Last Name:BECK
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 1:58 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-7753
Mailing Address - Country:US
Mailing Address - Phone:203-743-4834
Mailing Address - Fax:203-744-1323
Practice Address - Street 1:58 DIVISION ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-7753
Practice Address - Country:US
Practice Address - Phone:203-743-4834
Practice Address - Fax:203-744-1323
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4051264Medicaid
T23295Medicare UPIN
CT4051264Medicaid