Provider Demographics
NPI:1912065277
Name:BECKER CLINIC LTD
Entity Type:Organization
Organization Name:BECKER CLINIC LTD
Other - Org Name:BECKER CLINIC OF CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-483-4444
Mailing Address - Street 1:1533 FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151
Mailing Address - Country:US
Mailing Address - Phone:540-483-4444
Mailing Address - Fax:540-483-3601
Practice Address - Street 1:1533 FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151
Practice Address - Country:US
Practice Address - Phone:540-483-4444
Practice Address - Fax:540-483-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACL8301OtherRAILROAD MEDICARE
VA142471OtherANTHEM
U50677Medicare UPIN
GACL8301OtherRAILROAD MEDICARE