Provider Demographics
NPI:1861674418
Name:BECKER, JEFFREY P (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:P
Last Name:BECKER
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 1:8801 W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2316
Mailing Address - Country:US
Mailing Address - Phone:501-223-3314
Mailing Address - Fax:501-223-8023
Practice Address - Street 1:8801 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2316
Practice Address - Country:US
Practice Address - Phone:501-223-3314
Practice Address - Fax:501-223-8023
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007029226111N00000X
TN2316111N00000X
AR16062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1861674418Medicare UPIN