Provider Demographics
NPI:1285802538
Name:BECKER CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BECKER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-330-8600
Mailing Address - Street 1:17785 MASON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118
Mailing Address - Country:US
Mailing Address - Phone:402-330-8600
Mailing Address - Fax:402-330-8608
Practice Address - Street 1:17785 MASON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118
Practice Address - Country:US
Practice Address - Phone:402-330-8600
Practice Address - Fax:402-330-8608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1000758961OtherCORPORATION IDENTIFICATIO