Provider Demographics
NPI:1194157099
Name:BECK, JENNA DENISE (DC, BS)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:DENISE
Last Name:BECK
Suffix:
Gender:F
Credentials:DC, BS
Other - Prefix:DR
Other - First Name:JENNA
Other - Middle Name:DENISE
Other - Last Name:SCHULZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:100 COUNTRY VIEW DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-2054
Mailing Address - Country:US
Mailing Address - Phone:682-237-2322
Mailing Address - Fax:
Practice Address - Street 1:100 COUNTRY VIEW DR STE 300
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-2054
Practice Address - Country:US
Practice Address - Phone:682-237-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12402111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor