Provider Demographics
NPI:1437141249
Name:BECKHAM, GINA B (DC)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:B
Last Name:BECKHAM
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:PO BOX 50818
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79710-0818
Mailing Address - Country:US
Mailing Address - Phone:432-522-1548
Mailing Address - Fax:432-682-5505
Practice Address - Street 1:1802 W WALL ST
Practice Address - Street 2:SUITE C
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6522
Practice Address - Country:US
Practice Address - Phone:432-522-1548
Practice Address - Fax:432-682-5505
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
TX8121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608011OtherBCBS
TXV03011Medicare UPIN
8D0013Medicare ID - Type Unspecified