Provider Demographics
NPI:1336220086
Name:BECK, JIMMIE ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:JIMMIE
Middle Name:ANDREW
Last Name:BECK
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 1:13008 S 193RD EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-8006
Mailing Address - Country:US
Mailing Address - Phone:918-455-5861
Mailing Address - Fax:918-455-5811
Practice Address - Street 1:13008 S 193RD EAST AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-8006
Practice Address - Country:US
Practice Address - Phone:918-455-5861
Practice Address - Fax:918-455-5811
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor