Provider Demographics
NPI:1659453660
Name:BECCO, JEFFERY (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:
Last Name:BECCO
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 1:1819 W COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3872
Mailing Address - Country:US
Mailing Address - Phone:719-471-4174
Mailing Address - Fax:719-633-2198
Practice Address - Street 1:1819 W COLORADO AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3872
Practice Address - Country:US
Practice Address - Phone:719-471-4174
Practice Address - Fax:719-633-2198
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29323Medicare ID - Type Unspecified