Provider Demographics
NPI:1891982112
Name:BECKING CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BECKING CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:L
Authorized Official - Last Name:BECKING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-243-9777
Mailing Address - Street 1:528 E JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-2426
Mailing Address - Country:US
Mailing Address - Phone:573-243-9777
Mailing Address - Fax:573-243-9799
Practice Address - Street 1:528 E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-2426
Practice Address - Country:US
Practice Address - Phone:573-243-9777
Practice Address - Fax:573-243-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004010548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO706115OtherHEALTHLINK
MO196119OtherBLUE CROSS/BLUE SHIELD
MOV05477OtherUPIN
MO258414606Medicare PIN