Provider Demographics
NPI:1699843433
Name:BECKWITH, CHRISTOPHER SCOTT (DC DACNB)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:SCOTT
Last Name:BECKWITH
Suffix:
Gender:M
Credentials:DC DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3481 UTICA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1617
Mailing Address - Country:US
Mailing Address - Phone:563-345-1111
Mailing Address - Fax:563-345-1112
Practice Address - Street 1:3481 UTICA RIDGE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1617
Practice Address - Country:US
Practice Address - Phone:563-345-1111
Practice Address - Fax:563-345-1112
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
08123059OtherBLUE CROSS BLUE SHIELD
061664813Medicare UPIN
08123059OtherBLUE CROSS BLUE SHIELD