Provider Demographics
NPI:1669472924
Name:BECKER, SCOTT A (DC, FACO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:BECKER
Suffix:
Gender:M
Credentials:DC, FACO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:217-875-5399
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:217-875-5399
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003978111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5845669OtherBLUE CROSS BLUE SHIELD IL
IL038003978Medicaid
IL038003978Medicaid
ILT37438Medicare UPIN