Provider Demographics
NPI:1770018467
Name:BECKERTON CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:BECKERTON CHIROPRACTIC PLLC
Other - Org Name:FERNANDINA CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BECKERTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-704-9002
Mailing Address - Street 1:463392 EAST STATE ROAD 200
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097
Mailing Address - Country:US
Mailing Address - Phone:716-704-9002
Mailing Address - Fax:904-513-9206
Practice Address - Street 1:464073 EAST STATE ROAD 200
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32034
Practice Address - Country:US
Practice Address - Phone:716-704-9002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty