Provider Demographics
NPI:1760634042
Name:BECKWITH, NICHOLAS P (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:P
Last Name:BECKWITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5259 CAMERON CREEK PL
Mailing Address - Street 2:APT 177
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4612
Mailing Address - Country:US
Mailing Address - Phone:817-317-1808
Mailing Address - Fax:
Practice Address - Street 1:5001 S HULEN ST
Practice Address - Street 2:STE 107
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1968
Practice Address - Country:US
Practice Address - Phone:817-370-1300
Practice Address - Fax:817-370-1303
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX11232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor