Provider Demographics
NPI:1205890738
Name:BECKER, GREGORY WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WILLIAM
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 1:215 N SAN MATEO
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2674
Mailing Address - Country:US
Mailing Address - Phone:650-340-1110
Mailing Address - Fax:650-340-1115
Practice Address - Street 1:215 N SAN MATEO DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2674
Practice Address - Country:US
Practice Address - Phone:650-340-1110
Practice Address - Fax:650-340-1115
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28343111N00000X
CADC28343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0283430Medicare UPIN
CAU93473Medicare UPIN
DC0283430Medicare ID - Type Unspecified