Provider Demographics
NPI:1497918106
Name:SCOTT A & CHRISTINE M BECKER
Entity Type:Organization
Organization Name:SCOTT A & CHRISTINE M BECKER
Other - Org Name:ASSOCIATED BACK CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-875-7388
Mailing Address - Street 1:3419 N WOODFORD ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-2839
Mailing Address - Country:US
Mailing Address - Phone:217-875-7388
Mailing Address - Fax:217-875-7388
Practice Address - Street 1:3419 N WOODFORD ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-2839
Practice Address - Country:US
Practice Address - Phone:217-875-7388
Practice Address - Fax:217-875-7388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003978111N00000X
IL038004228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5815174OtherBLUE CROSS BLUE SHIELD OF ILLINOIS