Provider Demographics
NPI:1972799039
Name:BECKER, JOEL P (DC)
Entity Type:Individual
Prefix:
First Name:JOEL
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 1:1225 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-2864
Mailing Address - Country:US
Mailing Address - Phone:715-344-2990
Mailing Address - Fax:
Practice Address - Street 1:1225 MAIN ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-2864
Practice Address - Country:US
Practice Address - Phone:715-344-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4339-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1972799039Medicaid
WI701750180Medicare PIN