Provider Demographics
NPI:1285665083
Name:BECKER, BONNIE LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:LEE
Last Name:BECKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 UPPER ROCKY DALE RD
Mailing Address - Street 2:
Mailing Address - City:GREEN LANE
Mailing Address - State:PA
Mailing Address - Zip Code:18054-2541
Mailing Address - Country:US
Mailing Address - Phone:215-257-1092
Mailing Address - Fax:
Practice Address - Street 1:3 RIDGE RD
Practice Address - Street 2:
Practice Address - City:TELFORD
Practice Address - State:PA
Practice Address - Zip Code:18969-1327
Practice Address - Country:US
Practice Address - Phone:215-258-5633
Practice Address - Fax:215-258-5634
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-002773L111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0048435000Other10-DIGIT HMO ID