Provider Demographics
NPI:1407051485
Name:BECROFT, JAMES ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:BECROFT
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 1:5055 N. HARBOR DR
Mailing Address - Street 2:110
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106
Mailing Address - Country:US
Mailing Address - Phone:619-523-9355
Mailing Address - Fax:619-523-1544
Practice Address - Street 1:5055 N. HARBOR DR
Practice Address - Street 2:110
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106
Practice Address - Country:US
Practice Address - Phone:619-523-9355
Practice Address - Fax:619-523-1544
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor