Provider Demographics
NPI:1386040483
Name:BECKER, MALLORY (DC)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
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 1:60 OWENS DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2496
Mailing Address - Country:US
Mailing Address - Phone:973-790-1984
Mailing Address - Fax:973-790-4325
Practice Address - Street 1:60 OWENS DR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2496
Practice Address - Country:US
Practice Address - Phone:973-790-1984
Practice Address - Fax:973-790-4325
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00721300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor