Provider Demographics
NPI:1316020027
Name:BECKINGHAM, IAN INTEUS (DC)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:INTEUS
Last Name:BECKINGHAM
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 1:11110 OHIO AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3388
Mailing Address - Country:US
Mailing Address - Phone:310-614-2024
Mailing Address - Fax:
Practice Address - Street 1:11110 OHIO AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3388
Practice Address - Country:US
Practice Address - Phone:310-614-2024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3096111N00000X
CA30933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABU029AMedicare PIN