Provider Demographics
NPI:1700180320
Name:BECCO CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BECCO CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BECCO
Authorized Official - Suffix:
Authorized Official - Credentials:D,C,
Authorized Official - Phone:719-471-4174
Mailing Address - Street 1:1819 W COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3836
Mailing Address - Country:US
Mailing Address - Phone:719-471-4174
Mailing Address - Fax:719-633-2198
Practice Address - Street 1:1819 W COLORADO AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3836
Practice Address - Country:US
Practice Address - Phone:719-471-4174
Practice Address - Fax:719-633-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2465111N00000X
CO3970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08024655Medicaid
CO08039703Medicaid
CO602430000OtherCOLORADO DEPARTMENT OF LABOR
CO613074100OtherCOLORADO DEPARTMENT OF LABOR
CO08039703Medicaid
CO602430000OtherCOLORADO DEPARTMENT OF LABOR